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DocuSign Envelope ID:86AA2D69-2618-49CA-ABD9-3717E162CF6E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Summit Design and Engineering Services PLLC Party/Vendor Contact Person: Don Server,PE <br /> Contact Phone: 919.732.3883 Party/Vendor Address: 320 Executive Court City Hillsborough State: NC Zip: 27278 <br /> Department: AMS Amount: $4,200 Purpose: Orange County Puclic Transportation Admin Sewer tie in to TOH <br /> Budget Code(s): 61370035-870000-10075 Vendor# 53403 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 02/20/2020 <br /> Approved by Board Yes❑No® Agenda Date:N/A <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 Signatur QV1n'� Date2/19/2020 <br /> 2DD9CD6681844C5... <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 sufficient Wocusigned by: ' rds,specifications,and requirements: <br /> c,USX (ham 6 2/19/2020 <br /> Office of the Risk Management Office Date: <br /> 7FDCF91788a049S... <br /> Financial Services <br /> Ds This instrument has been pre-audited i ' DocuSigned by: the Local Government Budget and Fiscal Control Act: <br /> �L office of the Chief Financial Office 4 Date: 3/12/2020 <br /> 704E51S1ACC1409... <br /> Legal Services <br /> This agreement is approved as t ' D�tocu,,SSigned by:' 11 ciency: <br /> Office of the County Attorney 6%f`', hmv, Date: 3/12/2020 <br /> 14C5F3CDDFOB94F8... <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 />