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DocuSign Envelope ID: BDE3CDED-216E-4129-B5B9-ED290F2D91F9 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Penta Facility Group, LLC Party/Vendor Contact Person: Dan D. Blair, Jr, PE <br /> (dblair(d)pentaen,g com) Contact Phone: 919.455.0212 Party/Vendor Address: 4000 Miller Court West City <br /> Norcross State: GA Zip: 30071 Department: AMS Amount: $700.00 Purpose: Asbestos Testing for Piedmont <br /> Food Processing for Installation of Freezers Budget Code(s): 30600030 800000 71370 Vendor # 61470 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ® Renewal ❑ <br /> Amendment ❑ Effective Date 7/22/19 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 agreement: <br /> Q�,,,P/anx� <br /> Department Director's Signature[ Date:7/19/2019 <br /> , — <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 <br /> was addressed: N/A <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 Qt s� �#f° Date:7/19/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Fz Act: <br /> Office of the Chief Financial Officer r�I'N Date:7/23/2019 <br /> Leual Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney[�' ` Date:7/25/2019 <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 /> 9 <br />