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DocuSign Envelope ID:9F1BD1AE-AA3F-4F58-8FB2-A1C39A00321F <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Douglas P. Malinowski DBA Wellsmont Landscaping Party/Vendor Contact Person: Douglas P. <br /> Malinowski (doug@wellsmontnc.com) Contact Phone: 919-810-6282 Party/Vendor Address: 1005 Dimmocks Mill <br /> Road City Hillsborough State: NC Zip: 27278 Department: AMS Amount: $1,210.00 Purpose: Additioanl Culvert <br /> Cleaning for proper water flow and safety per attachment B work areas Budget Code(s): 61370035-880000-30001 <br /> Vendor# 64686 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) <br /> New ® Renewal ❑ Amendment ❑ Effective Date August 27, 2019 Approved by Board Yes❑ No® <br /> 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 � t Qnn�k Date: 8/22/2019 <br /> C, <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: N/A <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 Office KSO bn1t f° Date: 8/26/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> PL °" <br /> Office of the Chief Financial Officer[� q Date: 8/27/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorne "" �a�crfS Date: 8/28/2019 <br /> Y[ Ewa, <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 />