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Revised 12/18 4 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Party/Vendor Name: Hillsborough Self Storage Annex Party/Vendor Contact Person: Elizabeth Wells Contact Phone: <br />919-644-6776 Party/Vendor Address: 346A Elizabeth Brady Road City Hillsborough State: NC Zip: 27278 <br />Department: AMS Amount: $4900.00 Purpose: Storage for Public Defenders Files, BOCC files $3150, EMS <br />Remediation $1750 Budget Code(s): ($3150) 61370035-880000-10069, ($1750) 61370035-88030-10068 Vendor # <br />50376 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New <br />Renewal Amendment Effective Date 09/25/2020 Approved by Board Yes 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 />Department Director’s Signature ________________________________________ Date: ________ <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: EMS Relocation of Warehouse goods: urgent <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 />Office of the Risk Management Officer___________________________________ Date: _________ <br />Financial Services <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________Date: ________ <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 />DocuSign Envelope ID: A5EEE1F0-3C65-4C12-9C95-ED1B074B9C53 <br />10/5/2020 <br />10/6/2020 <br />10/8/2020 <br />10/8/2020