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DocuSign Envelope ID: B38F4611-6CFB-4CCB-9EF8-F272058BA03E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Douglas P. Malinowski Party/Vendor Contact Person: Douglas P. Malinowski Contact <br /> Phone: 919-810-6282 Party/Vendor Address: 1005 Dimmocks Mill Road City Hillsborough State:NC Zip:27278 <br /> Department: Planning Amount: $2,629.90 Purpose: Additional Erosion Control Matting and Permanent Seeding at <br /> Lake Orange Dam Budget Code(s): 51360120-571000 Vendor#64686 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ❑ Amendment ® Effective Date <br /> March 4,2019 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 /> FIE'DA']CM1C2 <br /> ��b, <br /> buv,M 2/28/2019 <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: <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 /> Qtasa ��t6 <br /> Office of the Risk Management Office usx Date:3/1/2019 <br /> ❑„�o�19E <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> ❑ �d r� <br /> .,d�q. 3/1/2019 <br /> Office of the Chief Financial Officer ❑C5191ACC HOD Date: <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ❑ s u br. <br /> Office of the County Attorney Jaakts 15vtipav<�❑C1z0S1�Af5 Date: 3/1/2019 <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 />