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ORANGE COUNTY—DEPARTMENT USE ONLY <br />_____________________________________________________________________________________________________ <br />Party/Vendor Name: Custom Stone NC, Inc Party/Vendor Contact Person: Daniel Benner Contact Phone: 919-682-8868 Party/Vendor Address: <br />1001 Ellis Drive City Durham State: NC Zip: 27703 Department: AMS Amount: $3150 Purpose: Extra Digging and Gravel at Veterans Memorial <br />Chapel Hill due to bad soil Budget Code(s): 61370035-880000-10060 Vendor # 57997 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 />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been <br />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 agreement have already begun or been <br />completed please briefly describe the nature of the emergency condition that was addressed: <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 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 07/20 <br />DocuSign Envelope ID: 0DC578EB-CB9B-4E2F-87EE-B72C1A252F0D <br />5/23/2022 <br />5/23/2022 <br />5/24/2022 <br />5/24/2022