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DocuSign Envelope ID:OB6A4D70-3138-422C-98BF-EA253C4BCA84 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Clean Harbors Environmental Services,Inc. Party/Vendor Contact Person: Joshua Hill Contact <br /> Phone: 336.289.8289 Party/Vendor Address: 6180-82 Old Mendenhall Road City Archdale State: NC Zip: 27263 <br /> Department: Solid Waste Amount: 7 070 Purpose: Cleanup of Fire Extimniishin,g Agent Budget Code(s): <br /> 50353020-571000 Vendor# (N/A if new vendor) Vendor is a BOCC consultant? YcK] M Contract <br /> Type: (Check one)New M Renewal[:] Amendment ❑Effective Date Approved by Board Yes Nb M <br /> Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initiated prior to execution of the agreement: <br /> DocuSignedby:RWA.wtS 2/27/2019 <br /> Department Director's Signature Date: <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:Fire Suppression System activated at the Household Hazardous Waste Facility at the Eubanks Road <br /> Waste and Recycling Center on Friday February 22,2019 releasing 90 pounds of Chemical Agent.Household <br /> Hazardous Waste Facility had to remain closed until clean up of chemical. <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 MM498 <br /> M' d''al1ri1ds,specifications,and requirements: <br /> Office of the Risk Management Officer rv�.c& Date:2/27/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned y: <br /> Office of the Chief Financial Officer�— 0.,Q of6 Date: 2/28/2019 <br /> �—7 D4 E 5181 ACC 1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney Ql yu, 'urit, T�S(b Date: 2/28/2019 <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 />