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DocuSign Envelope ID:3E565475-78A0-4C5D-AD10-C7A559DA7C44 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: 4C: Central Carolina Cleaning Company Inc Party/Vendor Contact Person: Raven Coleman <br /> Contact Phone: 919-937-9667 Party/Vendor Address: 4122 Bennett Memorial Drive Suite #207 City Durham <br /> State:NC Zip: 27705 Department: Emergency Services Amount: $13,750 Purpose: Temporary Decedant Storage <br /> Budget Code(s): 10750020-630000 Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes <br /> ❑ No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date Approved by <br /> Board Yes❑ No® Agenda Date: ---For Section XIV. c. contracts only,Approved by Board in Current FY <br /> Budget Yes❑No® <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated ri$octa%e ed%ytion of the agreement: <br /> 16 � �/. ._, 2/2/2022 <br /> Department Director's Signature 6 DO'S Date: <br /> Agreements for emergency services J%W 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 /> DocuSigned"by: <br /> ' 2/4/2022 <br /> Office of the Risk Management Officer &A V1n t,{fb Date: <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer ( Date: 2/4/2022 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: 2/4/2 02 2 <br /> Office of the County Attorney Date: <br /> FV <br /> 831A1DOB509646t1erk 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 /> Revised 06/21 <br /> 9 <br />