HomeMy WebLinkAboutR 2018-633 DEAPR - JV Brockwell playground resurfacing DocuSign Envelope ID:83CE5186-90BD-4376-B343-3887BADA96CD
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: r, V.Brockwell Trucking Party/Vendor Contact Person: Chuck Smith Contact Phone: 919-942-
3.001 Party/Vendor Address: 8821 Old NC 86 City Chapel Hill State:NC Zip:27516 Department: DEAPR Amount:
$1,760.00 Purpose: Replenish certified playground safety surfacing Budget Code(s): 10515020 572000 Vendor #
42666 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New
Renewal❑ Amendment ❑ Effective Date 9/4/2018 Approved by Board Yes[]No® Agenda.Date:
This agreement is approved as to technical form and content:.
DocuSigned by:
Department Director's Signature awl �fat,.61 Date: 9/4/2018
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:
DDocuSigned by:
Office of the Risk Management Officer 117FDCF9176800498 Gsa. C,6V1n.t,{�6 Date: 9/5/2018
..
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 6m�, 00.'1440. Date: 9/5/2018
..
Legal Services
This agreement is approved as to legal form and sufficiency:
Docusigned by:
Office of the County Attorney �66A, K6kk(S Date: 9/27/2018
EAAM33ED8AW5...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion: sin ersoll_,oran ecountync.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 14117(Mgr appry A 6118) 4
I