HomeMy WebLinkAboutR 2017-626-E SW - Four Star Petroleum Services, Inc. to provide and install pressure regulating valve DocuSign Envelope ID:AD251 D55-21 B9-4E45-B277-2076A6D0468D
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Four Star Petroleum Services, Inc. Party/Vendor Contact Person: Cecil Morgan Contact
Phone: 540-563-1022 Party/Vendor Address: 1119 Beaumont Rd. City Roanoke State: VA Zip: 24019
Department: Solid Waste Amount: 2,135 Purpose:Provide and Install Pressure Regulating Valve Budget Code(s):
50351020-571000 Vendor#64044 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract
Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 11-15-17 Approved by Board Yes'
No Agenda Date:
This agreement is approved as to technical form and content:
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Department Director's Signature G-ordoA, `1%vcloi Date:11/16/2017
25E5DBCA7B8941B...
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:
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Office of the Risk Management Officer ltttSA. rbvwc Date: 11/20/2017
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
, ---DocuSigned by:
11/20/2017
Office of the Chief Financial Officer (71.4.-N D-7D4E5181 ACC1409...
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney
at,UU, '4tI, 1 sco Date: 11/20/2017
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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 10/17
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