HomeMy WebLinkAboutR 2017-167-E DEAPR - JV Brockwell Trucking to replenish playground safety surfacing DocuSign Envelope ID: D7D97625-274B-4FD2-B140-A54CC257D87C
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: JV Brockwell Trucking Party/Vendor Contact Person: Chuck Smith Contact Phone: (919) 942-
3001 Party/Vendor Address: 8821 Old NC86 City Chapel Hill State:NC Zip:27516 Department: DEAPR Amount:
$1,760.00 Purpose: Replenish playground safety surfacing Budget Code(s): 10515020 630000 and 572000 Vendor#
42666 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New
Renewal❑ Amendment ❑ Effective Date 5/10/2017 Approved by Board Yes❑No Agenda Date:
This agreement is approved as to technical form and content:
DocuSigned by:
Department Director's Signature Piw.L Sltiad, Date:
�--611CFA1D507A495.,.
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:
DocuSigned by:
Office of the Risk Management Officer ((USX ( rt&L*& Date:
�---7FDCF9178800498...
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:
�---7D4E5181ACC1409...
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney (LA, (AA Date:
EAA3D33ED8A8465...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @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:
Revised 2/17 5