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DocuSign Envelope ID: BOOE2CO3-7FB1-43E1-B462-15595673B8DC <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Racanelli Construction South, Inc Party/Vendor Contact Person: Scott Drebitko <br /> (srebitko(a-)racanelliconstruction.com) Contact Phone: 919.363.3600 Party/Vendor Address: 1001 Pemberton Hill Rd, <br /> Suite 202 City Apex State: NC Zip: 27502 Department: AMS Amount: $4997.00 Purpose: Install eMoxy flooring <br /> from dock area into freezers to address environmental health, and install drainage to remove water from dock Budget <br /> Code(s): 34600020-880000-10076 Vendor#62963 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No <br /> ® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 1/15/20 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 /> Department Director's Signature S Qnn�k Date: 1/15/2020 <br /> C, <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: N/A <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 the Risk Management Office ESO bn1t f° Date:1/15/2020 <br /> rI,r,m,��,aR <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> PL <br /> Office of the Chief Financial Officer[ q Date: 1/15/2020 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney Date: 111712020 <br /> .,::-R 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 11/19 4 <br />