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DocuSign Envelope ID: E4B5FD19-D652-4A3B-AC06-FDA2578536CC <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Orange Grove Fire Department Party/Vendor Contact Person: Chief Steve <br /> McCauley Contact Phone: (919) 967-5858 Party/Vendor Address: 6800 Orange Grove Rd. City <br /> Hillsborough State: NC Zip: 27278 Department: Orange County Emergency Services Amount: <br /> $6,000.00 Annually Purpose: Co-location with fire department Budget Code(s): 1077520-630000 <br /> Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: <br /> (Check one) New ❑ Renewal ® Amendment ❑ Effective Date July 1, 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 <br /> state work on this project has not been initiated prior to execution of the agreement: <br /> UocuSigned by: <br /> � <br /> Department Director's Signature Date: 6/13/2019 <br /> 5655BC891A434473. <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to <br /> this agreement have already begun or been completed please briefly describe the nature of the emergency <br /> condition that was addressed: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed <br /> and is 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 /> Office of the Risk Management Officer Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal <br /> Control Act: DocuSigned by: <br /> Office of the Chief Financial Officer ` oaa,acc,4as. Date: 6/13/2019 <br /> Legal Services <br /> This agreement is approved as to le OocuSigned by: <br /> Office of the County Attorney �635C68304A4A�� 8'O'CA4 Date: 6/13/2019 <br /> 4 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: <br /> singersoll@orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Orange County Orange Grove Fire Company Substation Agreement <br /> Page 7 of 8 <br />