HomeMy WebLinkAboutR 2019-068 Solid Waste - Herndon Ice Machine Repair Contract.doc DocuSign Envelope ID: F90Cl87C-FA90-4F9D-8F69-89C8CB5166DB
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Herndon Party/Vendor Contact Person: Becky Herndon Contact Phone: 919-477-0451
Party/Vendor Address: 4310 N. Roxboro Rd City Durham State: NC Zip: 27704 Department: Solid Waste Amount:
685.00 Purpose: Repair Ice Machine Budget Code(s): 50350020-570000 Vendor # 52106 (N/A if new vendor)
Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑
Effective Date Approved by Board Yes❑No® Agenda Date:
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 prior to execution of the agreement:
" 'siigne'd1 by:
F40cu
u (AWWAS 2/7/2019
Department Director's Signature De Date:
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that was
addressed:
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:
DocuSigneed by:
Office of the Risk Management Officer PUS& r6�6 Date: 2/10/2019
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in"9ftWPcttnquired by the Local Government Budget and Fiscal Control Act:
[ rJ."_4 2/11/2019
Office of the Chief Financial Officer C74 Date:
Legal Services
This agreement is approved as to le fikwusiw*dtmfficiency:
Ql�t,lAL L �Stb 2/11/2019
Office of the County Attorney Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@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 12/18 4