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Revised 06/21 <br /> <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />_____________________________________________________________________________________________________ <br /> <br />Party/Vendor Name: Siemens Industry, Inc. Party/Vendor Contact Person: Antony Tejada-Puella (antony.tejada-puello@siemens.com) Contact Phone: <br />919.469.5095 Party/Vendor Address: 215 Southport Drive, Ste 900 City Morrisville State: NC Zip: 27560 Department: AMS Amount: $5,605.69 <br />Purpose: Southern Human Services Fire Alarm System Replace (3) Duct Detectors Budget Code(s): 61370035-880000-30001 Vendor # 53325 (N/A if <br />new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date <br />03/10/2023 Approved by Board Yes No Agenda Date: --- For Section XIV. c. contracts only, Approved by Board in Current FY Budget Yes <br /> No <br /> <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 initiated <br />prior to execution of the agreement: <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 already begun or been <br />completed please briefly describe the nature of the emergency condition that was addressed: 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 />Clerk to the Board <br /> <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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br /> <br />DocuSign Envelope ID: 041974F1-A4A5-4EA3-AA14-DE7F9A08745D <br />3/13/2023 <br />3/14/2023 <br />3/14/2023