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1 <br /> j, o <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name : Moffat Pipe Inc . Party/Vendor Contact Person : Jesse DuClau Contact Phone : 919 -235 - 5149 <br /> Party/Venylor Address : 4901 Unicorn Dr. City Wake Forest State $ NC Zip : 27587 Department : Planning & <br /> IInn sections Amount : $ 0 . 00 Purpose : Change Order # 8 Budget Code ( s) : 61370035 - 88000040054 Vendor # <br /> 1801656 (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 a ement : <br /> Department Director ' s Sign Date : <br /> Agreements for emergency s vices or r air are not ' ject to the above affirmation . If serv ' es relat d to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was 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 /> Office of the Risk Management Officer �- - � ` _ Date . z <br /> Financial Services <br /> This instrument has been pre - audited in the in er re it d by the Local Government Budget and Fiscal Control <br /> Act : <br /> Office of the Chief Financial Officer Date : 31a5lly <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency : <br /> Office of the County Attorney 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 l � <� <br /> Date : <br /> Revised 12/ 18 <br />