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Revised 11/19 <br />8 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: Summit Design and Engineering Services PLLC Party/Vendor Contact Person: Chris Berg <br />Contact Phone: 919.732.3883 Party/Vendor Address: 320 Executive Court City Hillsborough State: NC Zip: <br />27278 Department: AMS Amount: $10,700.00 Purpose: To complete Phase 1 of attached proposal dated 12/3/19 <br />Budget Code(s): 61370035-870000-30029 Vendor # 53403 (N/A if new vendor) Vendor is a BOCC consultant? <br />Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 12/16/19 <br />Approved by Board Yes No Agenda Date: N/A <br /> <br /> <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 /> <br /> <br />Department Director’s Signature ________________________________________ 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 <br />was addressed: <br /> <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br /> <br /> <br />DocuSign Envelope ID: 5E47B263-475D-41C8-9B4C-D71593E80C95 <br /> <br /> <br />