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DocuSign Envelope ID:2E2387F3-3A58-44C5-A8FF-30C659A8AB71 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: In-Water Services, Inc. Party/Vendor Contact Person: Mike Brian Contact Phone: 336-272- <br /> 5500 Party/Vendor Address: 3638 SE School Road City Greensboro State:NC Zip: 27406 Department: Planning <br /> Amount: $6,498.00 Purpose: Fabrication and Installation/Testing of Sluice Gate Stem Guides Budget Code(s): <br /> $1,499.00 will be billed to #61370035-880000-10074 (CIP); $4,999.00 will be billed to #10695020-720013 <br /> (Operations) Vendor#65918 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: <br /> (Check one)New ® Renewal ❑ Amendment ❑ Effective Date March 20,2020 Approved by Board Yes❑ <br /> 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 /> ❑ocusigned by: <br /> P g � l _�t.�«f 3/19/2020 <br /> Department Director's Signature Date: <br /> Manlrnnx.=na:� <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 /> 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 /> ❑ S'8 d hy: <br /> 1�Sa fan 6 3/19/2020 <br /> Office of the Risk Management Office Date: <br /> [__ <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> ❑ Sig c by: <br /> 3/19/2020 <br /> Office of the Chief Financial OfficerI Date: <br /> f M1=51R1ACC11[%i <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ❑ S'8 d hy: <br /> Office of the County Attorney1XMts �"L'' Date:3/19/2020 <br /> W,1n'A@0UWA4F, <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 />