HomeMy WebLinkAboutR 2019-163 AMS - Ivey Septic Service Cedar Grove septic repair DocuSign Envelope ID:67AC2034-7CB5-4A3D-AOEF-741 F12FE5C4E
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Ivey s Septic Tank Service,Inc Party/Vendor Contact Person: Kristal Ivey Contact Phone: 919-
732-5592 Party/Vendor Address: 1122 Brookhollow Rd City Efland State: NC Zip: 27243 Department: AMS
Amount: $3475.00 Purpose: Cedar Grove/OPT Septic tank service 2019 Budget Code(s): 10240320-630000 Vendor#
41326 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑
Renewal❑ Amendment ❑ Effective Date 3/15/2019 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:
DoeuSigned by:
Department Director's Signature 11W& P6V*iaan. Date:3/11/2019
21EF373ACD454EF..
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: Pumping to prepare for the Ag Summit
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 insr--.--D-o—Signed-ay: ----ifications,and requirements:
Office of the Risk Management Officer USa CbV1rt.C.{�6 Date:3/12/2019
7FOCF917B800498.
Financial Services
This instrument has been pre-audited in the man oocusigned by: Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date 3/13/2019
7NE51 81 ACC 1 4N — -
Legal Services
This agreement is approved as to legal for Uocusigned by:
�66A, K6kk S 3/14/2019
Office of the County Attorney Date:
EAA3D33ED8AE4S5..
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