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DocuSign Envelope ID:7BOB2B82-F1AO-422B-8780-5A55AE1F554A <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Warren Hay Mechanical Contractors Inc. Party/Vendor Contact Person: Ron LaPann, <br /> (Ron.LaPann(a)Warren-ham) Contact Phone: 919-732-4362 Party/Vendor Address: PO Box 818 City <br /> Hillsborough State: NC Zip: 27278 Department: Southern Human Services Boiler Section 4 Replacement <br /> Amount: Not to Exceed$15,868.00 Purpose: Southern Human Services-Boiler Repair Budget Code(s): 61370035- <br /> 800000-30018 Vendor# 25352 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br /> Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 09/30/2019 Approved by Board Yes❑ <br /> 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 /> Department Director's Signature s Q Date:lo/1/zo19 <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 <br /> was addressed: N/A <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> Office of the Risk Management Office QGs�,bn1t f° Date: 10/2/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> P[ Act: <br /> Office of the Chief Financial Officer "` Date:10/2/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney _'� rovh Date:10/2/2019 <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 5 <br />