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DocuSign Envelope ID: E3F790E6-E41D-4A21-9ACC-8F14487804C1 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Herndon Resturant Equipment Co. Inc. Party/Vendor Contact Person: Dale Ellis <br /> (daleghemdonbros.us) Contact Phone: 919.477.0451 Party/Vendor Address: 4310 N. Roxboro St. City Durham <br /> State: NC Zip: 27704 Department: Emergency Services Amount: $1,251 Purpose: Replace evaporator coil on cooler <br /> Budget Code(s): 10750020-571000 Vendor# 52106 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ <br /> No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date 10/8/19 Approved by Board <br /> 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 /> iIXA� )Nts 10/10/2019 <br /> Department Directors SignaturL]su .-RP 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: This is an urgent repair due to the nature(use)of the cooler.Work has been authorized to proceed pending <br /> contract approvals. <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 /> Qt su �evtu�{6 Office of the Risk Management Office, vaR Date: 10/10/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> PLo�vsa�� <br /> 10/11/2019 <br /> Office of the Chief Financial Officew Date: <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> b � 10/11/2019 <br /> Office of the County AttorneyDate:[ wa.p <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 />