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DocuSign Envelope ID: F52521E7-10C1-43F9-B62F-C1E599A5D572 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Douglas P. Malinowski Party/Vendor Contact Person: Douglas P. Malinowski Contact Phone: <br /> 919-810-6282 Party/Vendor Address: 1005 Dimmocks Mills Road City Hillsborough State: NC Zip: 27278 <br /> Department: Planning Amount: $3,125.00 Purpose: FY19-20 Stu= Removal and Fence Repair at Lake Orange Dam <br /> Budget Code(s): 10695020-720013 Vendor#64686 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ <br /> No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date August 23, 2019 Approved <br /> 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 /> Department Director's Signature �'�� '`�`L Date: 8/19/2019 <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 insurance standards,specifications,and requirements: <br /> Office of the Risk Management Officer etas"bnu ff0 Date: �tas�dew dte <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> 8/20/2019 <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> �° 8/20/2019 <br /> Office <br /> of the County Attorney J�"�S bri— Date: <br /> C�eae.w�.� <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 />