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DocuSign Envelope ID:80DF9584-55OF-4149-B79B-E7660248041B <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Custom Controls Unlimited, Inc. Party/Vendor Contact Person: Devin Carroll, Vice President <br /> Contact Phone: 919-661-5556 Party/Vendor Address: 2600 Garner Station Blvd. City Raleigh State: NC Zip: 27603 <br /> Department: Planning Amount: $1,663.00 Purpose: SCADA Modem Upgrade at Lake Orange Dam Site Budget <br /> Code(s): 10695020-720013 Vendor# 63654 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® <br /> Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date August 30, 2019 Approved by <br /> 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 /> 9/10/2019 <br /> Department Director's Signature CE, `� Date: <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 /> QUS&chw b 9/10/2019 <br /> Office of the Risk Management Officer Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> Sig by: <br /> Office of the Chief Financial Officer� ene�" Date:9/11/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney C J&w's enm& Date: <br /> ffi ,�� <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 />