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DocuSign Envelope ID:3CODC991-12E5-46CA-8516-26562639OE7B <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Douglas P.Malinowski DBA Wellsmont Landscaping Party/Vendor Contact Person: Douglas P. <br /> Malinowski (dougga,wellsmontnc.com) Contact Phone: 919-810-6282 Party/Vendor Address: 1005 Dimmocks Mill <br /> Road City Hillsborough State:NC Zip: 27278 Department: AMS Amount: $1,080.00 Purpose: Culvert Cleaning for <br /> proper water flow and safety Budget Code(s): 61370035-880000-30001 Vendor # 64686 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date July 22,2019 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 /> � p6mg 7/18/2019 <br /> Department Director's SignaturL,IX,�­ 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: 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 Office Qt s� �a��#f° Date: 7/18/2019 <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 rI-N Date: <br /> ?/19/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney �'r vh Date:7/30/2019 <br /> C� R-1 <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 4 <br />