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DocuSign Envelope ID:62694127-CO9A-45FE-823A-86A547COEFCD <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Douglas P. Malinowski Party/Vendor Contact Person: Douglas P. Malinowski Contact Phone: <br /> 919-810-6282 Party/Vendor Address: 1005 Dimmocks Mill Road City Hillsborough State: NC Zip: 27278 <br /> Department: Planning Amount: $425.00 Purpose: Spring 2019 Mowing at Sediment Control Structure No. 3 Budget <br /> Code(s): 10695020-720013 Vendor# 64686 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® <br /> Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date May 15, 2019 Approved by Board <br /> 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 /> �,.�Department Director's Signature r Date: 5/14/2019 <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 insurance standards,specifications,and requirements: <br /> 5d[NV,6 5/15/2019 <br /> Office of the Risk Management Officer _Y,Y,,,.� Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> 5/15/2019 <br /> Office of the Chief Financial Officer[ `; �` Date: <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> BLS 5/15/2019 <br /> Office of the County AttorneyE__,—, 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 12/18 4 <br />