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DocuSign Envelope ID:36676D3F-87BF-4638-9B2D-A546B334852F <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Ivey s Septic Tank Service,Inc Party/Vendor Contact Person: Kristal Ivey Contact Phone: 919- <br /> 732-5592 Party/Vendor Address: 1122 Brookhollow Rd City Efland State: NC Zip: 27243 Department: AMS <br /> Amount: $2800.00 Purpose: OPT Septic Tank service Budget Code(s): 10240320-630000 Vendor# 41326 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ❑ <br /> Amendment ❑ Effective Date 7/1/2019 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 /> DocuSigned by: <br /> 121 <br /> � 'I6��Department Director's Signature Date: 7/12/2019 <br /> EF373AC0454EF.. <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: <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 insu-----Do ed ay ----ifications,and requirements: <br /> aCisa wt.t,{�a <br /> Office of the Risk Management Officer Date: 8/6/2019 <br /> 1 <br /> 7FDCF917e800498. <br /> Financial Services <br /> This instrument has been pre-audited in the manner Docusigned by: wernment Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer O � Date:8/6/2019 <br /> 7NE5181ACC1409. — - <br /> Legal Services <br /> This agreement is approved as to legal form Docusigned by: <br /> Office of the County Attorney �6LW Pk� Date 8/7/2019 <br /> EAA3MaEMAW&— <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 />