HomeMy WebLinkAboutR 2019-398 AMS - Olive Hill Welding jail shower repair DocuSign Envelope ID:298C6E01-9C5E-4A68-8600-AF85E503B99D
ORANGE COUNTY-DEPARTMENT USE ONLY
Party/Vendor Name: Olive Hill Welding & Fabrication Inc Party/Vendor Contact Person: Josh Dickerson Contact
Phone: 336-592-4411 Party/Vendor Address: 1940 Semora Rd City Roxboro State: NC Zip: 27574 Department:
AMS Amount: $580.00 Purpose: Jail Welding Budget Code(s): 10240320-57000 Vendor # 62580 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) New ❑ Renewal ❑
Amendment ❑ Effective Date 07/01/2019 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:
DocuSigned by,
Department Director's Signature Oft* L Date: 6/28/2019
21EF373AC0454EF..
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 inst[&&
DocuSigned by:. ;ifications,and requirements:
Office of the Risk Management Officer L,QVInk&7FDCF0176800408. Date: 6/28/2019
Financial Services
This instrument has been pre-audited in the man DocuSigned by: Government Budget and Fiscal Control Act:
slJmnR.�w 6/30/2019
Office of the Chief Financial Officer ` 7NE5181aCC1400. Date:
Legal Services
This agreement is approved as to legal form and DocuSigned by:
�66A, �K6� 7/1/2019
Office of the County Attorney EAA3D33ED8AW5.. 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