HomeMy WebLinkAboutR 2019-531 AMS - Iveys Septic Service Cedar Grove DocuSign Envelope ID:C056BF26-9CDC-481A-B7FF-46409BFDE64C
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: $4150.00 Purpose: Cedar Grove Septic pumping of all tanks 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 7/1/2019 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 �� O6 ),40L Date:7/12/2019
21 E F373ACD454EF..
Agreements for emergency services or repair are not sunject to the anove 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 insur- boeusigned by: ----�fications,and requirements:
1US& (,bV1rt.C.{f6 8/6/2019
Office of the Risk Management Officer Date:
7FOCF9178800498.
Financial Services
This instrument has been pre-audited in the ma Docusigned by: l Government Budget and Fiscal Control Act:
1 8/6/2019
Office of the Chief Financial Officer 7NE5181ACCAH. Date:
Legal Services
This agreement is approved as to legal for DocuSigned by:
Office of the County Attorne �6LW Pk� Date: 8/7/2019
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El+AM33ED8AW' 5..
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