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<br />Revised 11/19 <br /> 10 <br /> <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: Clint Wilson Electric, Inc Party/Vendor Contact Person: Clint Wilson (clintwilsonelectric@gmail.com) <br />Contact Phone: 919-563-3540 Party/Vendor Address: PO Box 971 City Mebane State: NC Zip: 27302 Department: <br />AMS/ES Amount: $6510.00 Purpose: Emergency Services Building - Upgrade existing single phase meter and panel to three <br />phase Budget Code(s): 61370035-880000-30062 Vendor # 66400 (N/A if new vendor) Vendor is a BOCC consultant? <br />Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 8/1/2020 Approved by <br />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 <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: 821F9064-9210-4DC5-9640-9F07476D3F7C <br />8/2/2020 <br />8/3/2020 <br />8/3/2020 <br />8/3/2020