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DocuSign Envelope ID:2049FC36-OD70-41CA-B8EA-9117OB9D8CEF <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Summey Portable Restrooms Party/Vendor Contact Person: Christy Freeman Contact Phone: <br /> 336-417-1816 Party/Vendor Address: 2805 Miller Road City Hillsborough State: NC Zip: 27278 Department: <br /> DEAPR Amount: $1,575 Purpose: Waste Disposal of Restroom Trailer Budget Code(s): 630000 Vendor # 62844 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ® Renewal <br /> ❑ Amendment ❑ Effective Date 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 /> q��� �f��L DocuSigned by: r <br /> yl <br /> Department Director's Signature Date:4/30/2019 <br /> 871CFA1D507A495.. <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 sufficient DocuSigppned by: rds, specifications,and requirements: <br /> aUsa LQ 6 5/7/2019 <br /> Office of the Risk Management Office 7FDCF9176800498. Date: <br /> Financial Services <br /> This instrument has been pre-audited it17D4E,l,lA,,l,,, <br /> DocuSigned by: the Local Government Budget and Fiscal Control Act: <br /> 4 � 5/8/2019 <br /> Office of the Chief Financial Officer . Date: <br /> Legal Services <br /> This agreement is approved as t af�, �a�w�s / / <br /> DocuSigned by: iciency: <br /> Office of the County Attorney Date: 5 8 2019 <br /> EAA3D33ED8AW5.. <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 /> Ds <br /> GS <br />