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DocuSign Envelope ID: 1648A5F0-E971-4EFC-B3FA-2F3021D11A69 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Zoila L Rivas Party/Vendor Contact Person: Zoila I. Rivas Contact Phone: 919-475-9632 <br /> Party/Vendor Address: 1109 Montreux Drive City Mebane State:NC Zip:27302 Department: Planning Amount: <br /> $00 Purpose:Historic Rogers Road Area-LMI Sewer Connection Initiative-Property Owner Qualification Agreement <br /> for 7719 Rogers Road Budget Code(s): #61370035-880020-10054 Vendor#N/A-property owner will not receive <br /> payments from Orange County (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: <br /> (Check one)New® Renewal ❑ Amendment ❑ Effective Date October 9,2020 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 /> ° s„°°°" 10/6/2020 <br /> Department Director's Signature C+�'2 �`� Date: <br /> 868°,9°A3cF°Ocz... <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„ dey:Office of the Risk Management Officer[—, <br /> (,ov 6 Date: <br /> 10/7/2020 <br /> `]F°CF91]BB99498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> ° ss 10/8/2020 <br /> Office of the Chief Financial Officer[ n�^ -� Date: <br /> ]°6E5181ACc1009... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ° s'9 etl by: <br /> 10/8/2020 <br /> Office of the County Attorne �ON�S �'9"" Date:Y�� <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 /> October 2020 1.0 5 <br />