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DocuSign Envelope ID:76865915-80B4-4DED-A27B-62FD8E3D323A <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Summey Portable Restrooms Party/Vendor Contact Person: Harold Summey Contact Phone: 919.259.62 <br /> Address: 2805 Miller Rd City Hillsborough State: NC Zip: 27278 Department: AMS Amount: Increase Original PO 19018' <br /> $4,500.00. This is an increase of$2,700.00 Purpose: Emergency Services Trailer monthly restroom tank rental and pumping services <br /> 61370035-880000-10068 Vendor#62844 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Cl <br /> Renewal® Amendment ❑ Effective Date 7/29/2019 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 this project has <br /> prior to execution of the agreement: <br /> Q�P/anx� 7/15/2019 <br /> Department Director's Signature[IX _pF Date: <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have alread: <br /> completed please briefly describe the nature of the emergency condition that was addressed: N/A-Services under existing contract ex <br /> 2019. <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards, specifications,and requirements: <br /> Office of the Risk Management Office l s" bn1t f° Date: 7/16/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> PL <br /> Office of the Chief Financial Office "` Date: 7/18/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Y b 7/22/2019 <br /> Office of the County Attorney[—n R 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 Date: <br /> Revised 12/18 <br />