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DocuSign Envelope ID:A5F66F6C-3B2C-40FB-98B6-C183C558465E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: SIRS, Inc Party/Vendor Contact Person: Mike McClure Contact Phone: 336-574-3060 <br /> Party/Vendor Address: PO Box 36197 City Greensboro State:NC Zip: 27416 'Department: AMS Amount: $967.50 <br /> Purpose:PFAP Roof Budget Code(s): 10240320-570000 Vendor ft 57369 (NIA if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑No[] Contract Type:(Check one)New❑ Renewal ❑ Amendment ❑ Effective Date 2126/19 <br /> Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical farm 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 /> DocuSigned by: <br /> QW. PbOoJA, <br /> Department Director's Signature 21EFs7aAr_D454EF.. Date:3/6/2019 <br /> - <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 was <br /> addressed: Emergency roof leak repair for Piedmont Food and Ag Center. <br /> Information Technologies <br /> (Applicable only to har•dwarelsoftware 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' Qocusigned by: ' pecifications,and requirements: <br /> Q <br /> Office of the Risk Management Officer USA c6m&6 7FDCF0176800408. Date; 3/7/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the ma Docusigned by: T tl Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date:3/11/2019 <br /> 7D4E51S1ACC1409. <br /> Legal Services <br /> This agreement is approved as to legal fo DocuSigned by: <br /> I <br /> 3/11/2019 <br /> Office of the County Attorney EAasossEDaaaa 5.. Date.- <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 12118 4 <br />