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DocuSign Envelope ID:507D9E2F-FB6E-4E76-877E-AC5BC90428B3 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Siemens Industry Inc Party/Vendor Contact Person: _ Contact Phone: 336-574-3060 <br /> Party/Vendor Address: 215 Southport Dr Suite 900 City Morrisville State: NC Zip: 27560 Department: AMS <br /> Amount: $1,027.20 Purpose: Library Chiller Budget Code(s): 10240320-570000 Vendor # 53325 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ❑ <br /> Amendment ❑ Effective Date 8/20/2019 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 �� 9MA Date: 8/20/2019 <br /> 2DD9CD6681844C5. <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: This Invoice was due to an emergency repair to the Library.The cooler interlock switch failed.This caused <br /> the Chiller to shut down and the space to heat to over 82 degrees.The Library closed for 2 days due to unavailable parts. <br /> If you have any questions please let me know. <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 insurar Docusigned_by: <br /> . rations,and requirements: <br /> aUsa ( Q 6 8/21/2019 <br /> Office of the Risk Management Officer 7FDC F91 76900498. Dale: <br /> Financial Services <br /> This instrument has been pre-audited in the man oocusigned by: Government Budget and Fiscal Control Act: <br /> 8/21/2019 <br /> Office of the Chief Financial Officer 7NE5181ACC1409. Date: <br /> Legal Services <br /> This agreement is approved as to legal form an Docusigned by: <br /> Office of the County Attorney �6LW Pk�lfs Date: 8/21/2019 <br /> EAA3D33ED8A84S5.. <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 />