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DocuSign Envelope ID:6287A96E-3D08-4E5A-829C-DA75D9AF2941 <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 <br /> Norcross State: GA Zip: 30071 Department: AMS Amount: $5,000.00 Purpose: Lead & Asbestos Testing for <br /> Blackwood Farm House&Millhouse Parks Operatations Base House Budget Code(s): 10240320-630000 Vendor <br /> # 61470 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New <br /> ® Renewal ❑ Amendment ❑ Effective Date 2/15/19 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 /> m 2/12/2019 <br /> Department Director's Signature Date: <br /> C„ <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: A portion of this work was completed due to the employees working in the Blackwood Farm house <br /> and paint was peeling from the walls.The health and safety exposure to lead and asbestos deemed the partial work <br /> completed as urgent to protect the health of the employees. <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 /> Office of the Risk Management Officer kGs�,bn t#f° Date:2/12/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> P[ Act: <br /> Office of the Chief Financial Officers Date: 2/18/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney Date:2/19/2019 <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 />