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Revised 07/20 <br /> <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />_____________________________________________________________________________________________________ <br /> <br />Party/Vendor Name: Custom Stone NC, Inc Party/Vendor Contact Person: Daniel Benner Contact Phone: 919-682-8868 Party/Vendor Address: 1001 <br />Ellis Drive City Durham State: NC Zip: 27703 Department: AMS Amount: $1786 Purpose: To add mulch around the Veterans Memorial in Chapel <br />Hill Budget Code(s): 61370035-880000-10060 Vendor # 57997 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: <br />(Check one) New Renewal Amendment Effective Date Approved by Board Yes No Agenda Date: <br /> <br /> <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated <br />prior to execution of the agreement: <br /> <br /> <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 agreement have already begun or been <br />completed please briefly describe the nature of the emergency condition that was addressed: <br /> <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br /> <br />DocuSign Envelope ID: F005190C-8558-40C1-8ED1-FECDACCD60F8 <br />6/24/2021 <br />6/29/2021 <br />6/29/2021 <br />6/30/2021