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DocuSign Envelope ID:927B36D7-1719-466F-9E34-D267CB3B1E3F <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Penta Engineering Group, Inc Party/Vendor Contact Person: Dan D. Blair, Jr, PE <br /> (dblair(d)pentaeng com) Contact Phone: 919.455.0212 Party/Vendor Address: 4000 Miller Court West City a� <br /> Norcross State: GA Zip: 30071 Department: AMS Amount: $3,200.00 Purpose: Asbestos Testing for 510 <br /> Meadowlands Drive Budget Code(s): 61370035 870000 10068 Vendor#61470 (N/A if new vendor) Vendor is <br /> a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective <br /> Date 2/5/19 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> Docusignea cy: <br /> Department Director's Signature["^ '�S Date: z/11/zo19 <br /> Sg55BCgg1Ag44]3.. <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: N/A <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> D sg acy: <br /> Office of the Risk Management Office a'sa 6....: o Date:2/11/2019 <br /> 7FISL`F§T <br /> Financial Services <br /> LDS This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> PF Act: <br /> DocuSig—by: <br /> Office of the Chief Financial Officer[ Date:2/12/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> D Mgn.d by: <br /> Office of the County Attorne �0�""�a�wfi Date:2/12/2019 <br /> �E 3D3 E gA84 5.. <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 12/18 <br /> 9 <br />