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DocuSign Envelope ID:7EF04F9E-81 E3-46C4-l358E-2A08DD460FC4 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: American Industrial Contractor, Inc. Party/Vendor Contact Person: JAKE N JOHNSTON <br /> Contact Phone: (336) 213-4489 Party/Vendor Address: PO Box 16224 City Greensboro State: NC Zip: 27406 <br /> Department: Solid Waste Amount: 12,796.00 Purpose: Replace One HVAC system Budget Code(s): 50350020- <br /> 570000 Vendor# 59312 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: <br /> (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 2-10-2020 Approved by Board Yes❑No® <br /> Agenda Date: <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 /> DocuSigned by: <br /> nature w l� AS 2/24/2020 <br /> Department Director's Si Date:Agreements for emergency services or__ ssEssi sasssoass... _o 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 /> 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 Officer Qusa. (,DV1n 6 Date:2/24/2020 <br /> 7FDCF0176800408... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> Docu5igned by: <br /> Office of the Chief Financial Officer 2/25/2020 <br /> `�' '� Date: <br /> 704E51S1ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney �p , hmv, Date: 2/25/2020 <br /> 4C5FKDDF0694F8... <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 <br /> 9 <br />