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DocuSign Envelope ID:4813FED11-FCD9-49D7-81AD-DC7FF583EBC2 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Fossil Utility Group, Inc Party/Vendor Contact Person: Doug Willis Contact Phone: 336-232- <br /> 8970 Party/Vendor Address: 5132 Bartholomews Lane City Greensboro State: NC Zip: 27407 Department: AMS <br /> Amount: $1500 Purpose:Animal Services Locating Budget Code(s): 10240320-630000 Vendor#60548 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ❑ <br /> Amendment ❑ Effective Date 08/20/19 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 /> E <br /> ocu5igned by: 1�0 <br /> Department Director's Signature kmA Date: 9/26/2019 <br /> Agreements for emergency services or refo❑sc❑aesls4ac5. o 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: Efforts were made to place the vendor under contract. Less than a week before the larger project was to <br /> begin,the contractor determined that he had issued the wrong quote and would need to requote the job. Based on the <br /> importance of the overall project to Animal Services,which involved switching the utility service of the building from <br /> one source to another,a decision was made to move forward without a contract. <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 /> DocuSigned by: <br /> Office of the Risk Management Officer aUsa LQwu 6 Date: 9/26/2019 <br /> 7F,CF9176800498. <br /> Ds <br /> Financial Services Ep <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer Date: <br /> 9/26/2019 <br /> s�gx.w�ra. <br /> 7NE5181ACC1409. <br /> Leual Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney �6� K6kk 5 Date:9/27/2019 <br /> EAA3D33ED8AW5.. <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 />