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DocuSign Envelope ID:740BA81E-87D3-43AA-B2AC-DB756387E9EC <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Warren-Hay Party/Vendor Contact Person: Ron LaPann Contact Phone: 919-732-4362 <br /> Party/Vendor Address: PO Box 818 City Hillsborough State: NC Zip: 27278 Department: AMS Amount: $287.50 <br /> Purpose: Library Boiler Gas Leaks Budget Code(s): 10240320-570000 Vendor # 25352 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ❑ Amendment ❑ <br /> Effective Date 9/21/2019 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 /> Docusigned by: <br /> Department Director's Signature Siw• kmh Date: 10/17/2019 <br /> Agreements for emergency services or repair are nui°uojeCL LO n aoove 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: Per Paul Sorrell,Received a phone call on a Saturday morning from fire marshal that Dominion energy <br /> located leaks at boilers that operate library.Maintenance does not stock 1.5 fittings therefore Warren Hay was called to <br /> complete job and return the boilers back into operation.Library can not operate without the use of boilers. <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 insu Docusianed_by: ifications,and requirements: <br /> sa �AV1n.�.�b 10/23/2019 <br /> Office of the Risk Management Officer 7F❑CF9176900498. Date: <br /> Financial Services <br /> This instrument has been pre-audited in the mar Docusigned by: 1 Government Budget and Fiscal Control Act: <br /> 10/23/2019 <br /> Office of the Chief Financial Officer 7D4E5181A=400. Date: <br /> Legal Services <br /> This agreement is approved as to legal form 0DEAA3D3aED&AW5_ <br /> Docusigned by: <br /> Office of the County Attorney 6LW �bk� Date10/24/2019 <br /> . <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 />