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DocuSign Envelope ID:632D2AA8-DECD-4F1 F-986C-1 FADA9BC39E2 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Wolverine Pump & Utility, LLC Party/Vendor Contact Person: Timothy Jacobs Contact <br /> Phone: 919-257-3430 Party/Vendor Address: 117 W. Union Street City Hillsborough State: NC Zip: 27278 <br /> Department: Planning Amount: $31,646.00 Purpose: Historic Rogers Road Area- Installation of OWASA Sewer <br /> Service Stub-Out for 7731 Rogers Road Budget Code(s): #61370035-880000-10054(Construction) Vendor#N/A <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New® Renewal <br /> ❑ Amendment ❑ Effective Date June 30,2022 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 <br /> this project has not been initiated prior to execution of the agreement: <br /> 6/30/2022 <br /> Department Director's Signature (M Sf6tr Date: <br /> C 9IBEBE]D595A44J... <br /> Agreements for emergency services or repair are not 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 /> g QUsa(eviuffa 7/6/2022 <br /> Office <br /> of the Risk Management Officer Date: <br /> ]FDCF9t]6800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> ­51g <br /> Office of the Chief Financial Officer Date: 7/6/2022 <br /> 2F52D29B14]F405... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> by: <br /> 7/6/2022 <br /> Office of the County Attorney �j 1 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 /> October 2020 1.2 8 <br />