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DocuSign Envelope ID:8B33E7F9-56F2-4F51-A7E8-3B3F4ADFDA6D <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor- Name: Siemens Industry Inc Party/Vendor Contact Person: — Contact Phone: 336-574-3060 <br /> Party/Vendor Address: 215 Southport Dr Suite 900 City Morrisville State: NC Zip: 27560 Department: AMS <br /> Amount: $798.80 purpose: Cedar Grove Panel Repair- Budget Code(s): 10240320-570000 Vendor 4 53325 (N/A if <br /> new vendor-) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) New ❑ Renewal ❑ <br /> Amendment ❑ Effective Dale 06/14/2019 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initialed prior to execution of the agreement: <br /> DocuSigned by: <br /> 'I6 6/28/2019 <br /> Department Director's Signature Date: <br /> 21EF373ACD454EF.. <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that was <br /> addressed: Fire system in trouble status causing alarm to activate and sound hourly. <br /> Information Technologies <br /> (,4pplicable onl),to harrhvarelsoftware purchases or related services}This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Mann ement <br /> This agreement is approved for sufficiency of insur­n --l—Ac --ifications,and requirements: <br /> WcuSigneed_by: <br /> Office of the Risk Management Officer 1U$A, r"_ W 6 Date:6/28/2019 <br /> 7FDCF917e800498. <br /> Financial Services <br /> This instrument has been pre-audited in the ma Docusigned by: d Government Budget and Fiscal Control Act: <br /> Office of the Chief)Financial Officer � Date:6/29/2019 <br /> 7D4E5181Ar-C1400. <br /> Legal Services <br /> This agreement is approved as to legal forth and su-J bocusigned by: <br /> Office of the County Attorney �b Date:7j1/2019 <br /> EAA3D33EDSAW5.. <br /> Cleric to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singei,soll@orangecountync.gov <br /> The following signature block is for hard copies only and is not requh-ed for Docusign contracts: <br /> Office of the Cleric to the Board Date; <br /> Revised 12/18 4 <br />