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DocuSign Envelope ID:58936744-93CF-49DD-8E3B-8686F5361 F84 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: HEPACO Party/Vendor Contact Person: Joshua Johnson Contact Phone: 704-598-9782 <br /> Party/Vendor Address: PO Box 26308 City Charlotte State: NC Zip: 28221 Department: AMS Amount: <br /> 6 250.00 Purpose: Courthouse Storm Water Clean out Budget Code(s): 10240320-570000 Vendor#63505 (N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal ❑ <br /> Amendment ❑ Effective Date 8/30/2019 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 <br /> on this project has not been initiated prior to execution of the agreement: <br /> DLL ..ocu''Signed by: <br /> Department Director's Signature 12DD9CD6B81844C5_ <br /> r�- Q�► A Date: 8/20/2019 <br /> Agreements for emergency services or repair are not suuject 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 <br /> was 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 insurar^-coccus 9n aby`:---;f cations,and requirements: <br /> Office of the Risk Management Officer �US66 (,6_ 6 Date:8/23/2019 <br /> 7FDC F91 768004M <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officer 7❑4E5181ACC1409. Date: 8/23/2019 <br /> Legal Services <br /> This agreement is approved as to legal form an' ---o`cuSigned by: <br /> Office of the County Attorney �EAMD33EMAW5_ <br /> 6LW Pkk , 5 Date:8/26/2019 <br /> . <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 <br /> 8 <br />