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DocuSign Envelope ID:610F4570-A7E9-4B6B-B023-E816BA4952B3 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Summery Portable Restrooms Party/Vendor Contact Person: Harold Summey Contact Phone: <br /> 919-259-6266 Party/Vendor Address: 2805 Miller Rd City Hillsborough State: NC Zip: 27278 Department: AMS <br /> Amount: $1800.00 Purpose: Emergency Services Trailer Restroom Service Budget Code(s): 61370035 880000 10068 <br /> Vendor# 62844 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) <br /> New❑ Renewal ❑ Amendment ❑ Effective Date 3/30/2018 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 on <br /> this project has not been initiated prior to execution of the agreement: <br /> DocuSigned dy- <br /> �� 06V�t0L 3/29/2019 <br /> Department Director's Signature 21EFMAco454EF.. 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 was <br /> 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 insL DocuSigned <br /> _ay:. ifications,and requirements: <br /> 9US& cb b 3/29/2019 <br /> Office of the Risk Management Officer 7FDC F91 76 900498. Date: <br /> Financial Services <br /> This instrument has been re-audited in the m..___. --_---=-_a L- T -cal Government Budget and Fiscal Control Act: <br /> 1� DocuSigned dy: g <br /> Office of the Chief Financial Officer 01.44� Date: 4/1/2019 <br /> 704E5981ACC1409. <br /> Legal Services <br /> This agreement is approved as to legal form a DocuSigned by: <br /> �66, K6�tvfs <br /> Office of the County Attorney EAA3MaED8A84S5.. Date: 4/4/2019 <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 4 <br />