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DocuSign Envelope ID: E7280C15-9FB3-4lA8-848B-04166A2932E2 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Summey Portable Restrooms Party/Vendor Contact Person: Christy Freeman Contact Phone: <br /> 336-417-1816 Party/Vendor Address: 2805 Miller Road City Hillsborough State: NC Zip: 27278 Department: <br /> DEAPR Amount: $3,375 Purpose: Waste Disposal of Restroom Trailer Budget Code(s): 6300000 Vendor# 62844 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal <br /> ® Amendment ❑ Effective Date 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 /> awlDocuSigned by:Department Director's Signature1P., <br /> gawa Date: 9/11/2019 <br /> 1CFA1D507A405.. <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 sufficienc -Diocusigned by: 'ds, specifications,and requirements: <br /> Musa (ham 6 9/16/2019 <br /> Office of the Risk Management Officer 7FDCF9176800498. Date: <br /> Financial Services <br /> This instrument has been pre-audited i DocuSigned by: the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer I 411-, Date:9/17/2019 <br /> 7D4E5181ACC1400. - <br /> Legal Services <br /> This agreement is approved as to DocuSigned by: ciency: <br /> �bLW Pkku s 9/18/2019 <br /> Office of the County Attorney Date: <br /> El+A3D33ED8AE4S5.. <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 /> r[Ds <br /> Revised 12/18 4 VJ <br />