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DocuSign Envelope ID: B87D26F4-8DFD-42F4-9EA6-lD3CBD6749F3 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Siemens Industry Party/Vendor Contact Person: Joe Latore (joseph.latorenu siemens.com) Contact <br /> Phone: 984.292.7638 Party/Vendor Address: 215 Southport Drive Ste 900 City Morrisville State: NC Zip: 27560 <br /> Department: AMS Amount: $7,620.00 Purpose: Seymour Center Ionization for new portion of great hall Budget Code(s): <br /> 61370035-880001-10065 Vendor# 53325 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br /> Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 1/21/2021 Approved by Board Yes❑ No® <br /> Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this <br /> project has not been initiated prior to execution of the agreement: <br /> D 5'g g by: <br /> Department Director's Signature V � Date:1/15/2021 <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have <br /> already begun or been completed please briefly describe the nature of the emergency condition that was addressed: N/A <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards, specifications,and requirements: <br /> D sg aby: <br /> Office of the Risk Management Office 'Usa(anu$e Date:1/15/2021 <br /> ,FDCF9T9B8(R69g.. <br /> Financial Services <br /> Ds This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> P( 0 Sig—by: <br /> Office of the Chief Financial Officer 0" `" Date:1/21/2021 <br /> �,D�s,g.0 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> D s'g g by: <br /> Office of the County y Attorne '� hyyiv, Date:1/21/2021 <br /> �acscaccocue�ce_. <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@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 07/20 10 <br />