HomeMy WebLinkAboutR 2015-611-E AMS - Blossman Gas, Inc. dba Alliance Autogas - provision of propane vehicle fuel - Customer Agreement dated 7-1-2015 DocuSign Envelope ID:02FOB961-A92E-4131E-AOE9-E5777906432F
ORANGE COUNTY DEPARTMENT USE ONLY
Deuartment
Party/Vendor Name: Blossman Gas, Inc., d/b/a Alliance Autogas Party/Vendor Contact Person: Michael Phillips
Contact Phone: 704-574-4927 Party/Vendor Address: 2091 US Highway 70 City Swannanoa State: NC Zip:
28778 Department: AMS Amount: not to exceed $450,000 as part of the County fuel budget Purpose: The
provision of propane vehicle fuel pursuant to Exhibit A:Alliance Aurogas Customer Agreement,dated 7-1-
2015 Budget Code(s): 10240420-5460100 Vendor 4 63490 (N/A if new vendor) Vendor is a BOCC consultant?
Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7-1-2015
Approved by Board Yes®No❑ Agenda Date: 6-16-2015
This agreement is approved as to technical fo—
rn;.4r nt:
Department Director's Signature 66 1 Date: 11/25/2015
9E880A46C F64498...
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 ins} 9ee§t""an'dl1alLyds,specifications,and requirements:
Office of the Risk Management Officer auSa (hm, b Date: 11/29/2015
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
DocuSigned by:
Office of the Chief Financial Officer
Date: 12/3/2015
7D4E5181ACC1409...
Legal Services
This agreement is approved as to legal form and �fgceeacy:
Office of the County Attorney 56"Ocu
. �o ufs Date: 12/3/2015
AA3D33EDSA8465...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Doll2ydLvorangecounlyne.go v
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 10/14 9