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l <br /> ORANGE COUNTY- --DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name : NCDEQ Party/Vendor Contact Person : Christopher J . Sandt, P . E . , Staff Engineer <br /> Contact Phone : 919 -245 -2583 Party/Vendor Address : 3800 Barrett Drive City Ralei State : NC Zip . 27609 <br /> Department : Planning Amount : $ 520 associated NCDEQ application fee) Purpose : NEED COUNTY MANAGER <br /> SIGNATURE ON REVISED FINANCIAL RESPONSIBILITY/OWNERSHIP FORM FOR NCDEQ EROSION <br /> AND SEDIMENT CONTROL PERMITTING OF THE MLLSBOROUGH AREA EDD WATER AND SEWER <br /> EXTENSION PROJECT Budget Code(s) : 61370035 - 850000 -30048 Vendor #N/A (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes ❑ No ® Contract Type : (Check one) New ❑ Renewal ❑ Amendment ❑ <br /> Effective Date July 9 , 2018 Approved by Board Yes ❑ No ® Agenda Date : <br /> This agreement is approved as to technical fo and conten . <br /> Department Director ' s Signature Date : w <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 /> Office of Risk Management � � C .� � r Date . <br /> Financial Services <br /> This instrument has been pre- audited in the er equir d by the Local Government Budget d Fiscal Control <br /> Act . <br /> Office of the Chief Financial Officer Date : L / <br /> Legal Services <br /> This agreement is approved as to legal form and fficie c <br /> Office of the County Attorney Date . /Q <br /> Clerk to the Board <br /> Received for record retention : <br /> Office of the Clerk to the Board Date . <br /> Revised 10/ 17 <br /> I <br />