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DocuSign Envelope ID:C056BF26-9CDC-481A-B7FF-46409BFDE64C <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: $4150.00 Purpose: Cedar Grove Septic pumping of all tanks Budget Code(s): 10240320-630000 Vendor# <br /> 41326 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ <br /> Renewal❑ 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 /> Department Director's Signature �� O6 ),40L Date:7/12/2019 <br /> 21 E F373ACD454EF.. <br /> Agreements for emergency services or repair are not sunject to the anove 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 insur- boeusigned by: ----�fications,and requirements: <br /> 1US& (,bV1rt.C.{f6 8/6/2019 <br /> Office of the Risk Management Officer Date: <br /> 7FOCF9178800498. <br /> Financial Services <br /> This instrument has been pre-audited in the ma Docusigned by: l Government Budget and Fiscal Control Act: <br /> 1 8/6/2019 <br /> Office of the Chief Financial Officer 7NE5181ACCAH. Date: <br /> Legal Services <br /> This agreement is approved as to legal for DocuSigned by: <br /> Office of the County Attorne �6LW Pk� Date: 8/7/2019 <br /> y <br /> El+AM33ED8AW' 5.. <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 />