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DocuSign Envelope ID:9328CCEF-D384-4D87-A63F-17407DE1DAC5 <br /> DS <br /> ORANGE COUNTY—DE PART MENT USE ONLY j <br /> Party/Vendor Name: Sasser Companies, Inc Party/Vendor Contact Person: Kevin Sasser Contact Phone: 336- <br /> 516-5140 Party/Vendor Address: PO Box 10 City Whitsett State: NC Zip: 27377 Department: AMS Amount: <br /> $11,841.25 Purpose: Soltys Remediation Initial MIT Budget Code(s): 61370035-880000-10071 Vendor# 65006 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ <br /> Renewal❑ 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 <br /> on this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> P[.V. VbVt .,A. 5/16/2019 <br /> Department Director's SignatureDate: <br /> Agreements for emergency services or rep ' Alt-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: Emergent work in Soltys center due to evidence of mold,and the need to remediate. <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned by: <br /> g PUS4, <br /> (,6n t 6 5/16/2019 <br /> Office of the Risk Mana ement OfficerDate: <br /> 7FDCF9176800498... <br /> F <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 /> DocuSigned by: <br /> Office of the Chief Financial Officer Date: 5/16/2019 <br /> 7NF5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> 5uSigned by: <br /> 6Z, •• ,'.�Office of the County Attorney Oafs s Date:5/16/2019 <br /> EAA3D33ED6A8465_.. <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 5 <br />