2022-215-E-Planning-Wolverine Pump and Utility-Historic Rogers Road Area -LMI Sewer Connection Initiative Sewer Lateral connection services agreement for 1898 Priscilla Lane

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DocuSign Envelope ID:4D7650A1-DEC F-4F10-A64A-44A2E32E000A ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: Wolverine Pump & Utility, LLC Party/Vendor Contact Person: Timothy Jacobs Contact Phone: 919-257-3430 Party/Vendor Address: 117 W. Union Street City Hillsborough State: NC Zip: 27278 Department:Planning Amount: $7,005.00 Purpose:Historic Rogers Road Area-LMI Sewer Connection Initiative- Sewer Lateral Connection Services Agreement for 1898 Priscilla Lane Budget Code(s): #61370035-880020-10054 Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New® Renewal❑ Amendment ❑ Effective Date May 24,2022 Approved by Board Yes❑No® Agenda Date: 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 prior to execution of the agreement: D Signed by: Department Director's Signature fi t' f k. Date:5/23/2022 78FC4980286D4F2... Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: Do..Signed by: Office of the Risk Management Officer�Usa �ewu ¢o Date: 5/23/2022 �7F6DF9Ti ... Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Du..Signed by: Office of the Chief Financial Officer E. Date: 6/7/2022 Legal Services This agreement is approved as to legal form and sufficiency: za;ts .Signed by: alnOffice of the County Attorney � Date: 6/8/2022 Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: October 2020 1.2 8