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DocuSign Envelope ID: DAFC7BC0-27FF-4433-AC79-DA33894C5C89 <br /> GRANGE COUNTY---DEPARTMENT USE ONLY <br /> Party/Vendor Name: Siemens Indus" Inc Party/Vendor Contact Person: _ Contact Phone: 336-574-3060 <br /> Party/Vendor Address: 215 Southport Dr Suite_900 City Morrisville State: NC lip: 27560 Department: AMS <br /> Amount:$912.68.00 Purpose:Cedar Grove Panel Repair Budget Code(s): 10240320-570000 Vendor#53325 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes [] No❑ Contract Type: (Check one)New ❑ Renewal ❑ <br /> Amendment ❑ Effective Date 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 initiated prior to execution of the agreement: <br /> UocuSigned by: <br /> �W' Pbl't+►1GUA' 6/28/2019 <br /> Deparimeni Director's Signature 21 EF373Aco454EF-- Date' <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 /> I <br /> (Applicable onbl to hardwarelsof}care purchases or related services)This agreement has been reviewed and is I; <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 insure-----D-o'c-u--A USA �11- : " <br /> Sig <br /> c6nu �b-- -- ications,and requirements: <br /> a <br /> Office of1 the Risk Management Officer USA <br /> 6/28/2019 <br /> 7F©CF917E800498- <br /> Financial Services <br /> This instrument has been pre-audited in the 6/29/2019 <br /> Date:ma DocuSigned dy: al Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer' _ <br /> --- 704E51S1ACC1409- <br /> Legal Services <br /> This agreement is approved as to legal form 'oocusigned by: <br /> � <br /> Office of the County Attorney b� Pk�f5 __Date: 7/1/2019 <br /> El+A3033EO8A8435.. <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singerso[l@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 12/19 4 <br />