HomeMy WebLinkAboutR 2019-205 AMS - Summey Portable Restrooms ES trailer DocuSign Envelope ID:610F4570-A7E9-4B6B-B023-E816BA4952B3
ORANGE COUNTY-DEPARTMENT USE ONLY
Party/Vendor Name: Summery Portable Restrooms Party/Vendor Contact Person: Harold Summey Contact Phone:
919-259-6266 Party/Vendor Address: 2805 Miller Rd City Hillsborough State: NC Zip: 27278 Department: AMS
Amount: $1800.00 Purpose: Emergency Services Trailer Restroom Service Budget Code(s): 61370035 880000 10068
Vendor# 62844 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one)
New❑ Renewal ❑ Amendment ❑ Effective Date 3/30/2018 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:
DocuSigned dy-
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Department Director's Signature 21EFMAco454EF.. 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 insL DocuSigned
_ay:. ifications,and requirements:
9US& cb b 3/29/2019
Office of the Risk Management Officer 7FDC F91 76 900498. Date:
Financial Services
This instrument has been re-audited in the m..___. --_---=-_a L- T -cal Government Budget and Fiscal Control Act:
1� DocuSigned dy: g
Office of the Chief Financial Officer 01.44� Date: 4/1/2019
704E5981ACC1409.
Legal Services
This agreement is approved as to legal form a DocuSigned by:
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Office of the County Attorney EAA3MaED8A84S5.. Date: 4/4/2019
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