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DocuSign Envelope ID: FF5125CC-D956-4503-BB99-1218A92 DAB F1 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: BIRS, Inc Party/Vendor Contact Person: Mike McClure Contact Phone: 336-574-3060 <br /> Party/Vendor Address: PO Box 36197 City Greensboro State:NC Zip: 27416-6197 Department: AMS Amount:Not <br /> to Exceed(One Thousand Three Hundred Seven Dollars and Fifty Nine Cents) $1307.59 Purpose: Reseal Area Drain- <br /> Southern Human Services Budget Code(s): 10240320-570000 Vendor# 57369 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date <br /> 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 Signat fwt �y� Date:3/2/2020 <br /> Agreements for emergency servi 2D❑9C❑6e81844C5... 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: Service Call:Address leak above room#116.BIRS Invoice#31540 Job# 15-6358 <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 /> DocuSigned by: <br /> Office of the Risk Management Offi aUSA c4Wt.t& Date: 3/3/2020 <br /> DS 7FDCF9176800498... <br /> �L Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Offic lr7NE5181ACCAH <br /> '� '� Date:3/3/2020 <br /> . <br /> Legal Services <br /> This agreement is approved as to leual form and sufficiency: <br /> DocuSigned by'. <br /> Office of the County Attorn 1?C5F3CDDF0B94F6 <br /> %f t, �l.Vl v, Date: 3/3/2020 <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 11/19 4 <br />