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<br />Revised 11/19 <br /> 10 <br /> <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: Intellicom, Inc Party/Vendor Contact Person: Mike Bullock (mike@intellicomusa.com) Contact Phone: <br />919.957.1949 Party/Vendor Address: 2902 S. Miami Blvd, Ste C City Durham State: NC Zip: 27703 Department: AMS <br />Amount: $12,373 base, and $5000 Contingency for total $NTE$17,353.00 Purpose: Install new fiber line in order for new site <br />improvements to take place Budget Code(s): 61370035-880000-10065 Vendor # 44533 (N/A if new vendor) Vendor is a <br />BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date <br />7/22/2020 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 <br />project has not been initiated 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 <br />already begun or been completed please briefly describe the nature of the emergency condition that was addresse d: N/A - No <br />work as started. <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 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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br /> <br /> <br />DocuSign Envelope ID: C357B702-8D6A-4E3A-A92C-1C5F7F9AED63 <br />7/23/2020 <br />7/23/2020 <br />7/27/2020 <br />7/28/2020