HomeMy WebLinkAboutR 2019-560 AMS - Siemens Industries Library chiller DocuSign Envelope ID:507D9E2F-FB6E-4E76-877E-AC5BC90428B3
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Siemens Industry Inc Party/Vendor Contact Person: _ Contact Phone: 336-574-3060
Party/Vendor Address: 215 Southport Dr Suite 900 City Morrisville State: NC Zip: 27560 Department: AMS
Amount: $1,027.20 Purpose: Library Chiller Budget Code(s): 10240320-570000 Vendor # 53325 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ❑
Amendment ❑ Effective Date 8/20/2019 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 �� 9MA Date: 8/20/2019
2DD9CD6681844C5.
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: This Invoice was due to an emergency repair to the Library.The cooler interlock switch failed.This caused
the Chiller to shut down and the space to heat to over 82 degrees.The Library closed for 2 days due to unavailable parts.
If you have any questions please let me know.
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 insurar Docusigned_by:
. rations,and requirements:
aUsa ( Q 6 8/21/2019
Office of the Risk Management Officer 7FDC F91 76900498. Dale:
Financial Services
This instrument has been pre-audited in the man oocusigned by: Government Budget and Fiscal Control Act:
8/21/2019
Office of the Chief Financial Officer 7NE5181ACC1409. Date:
Legal Services
This agreement is approved as to legal form an Docusigned by:
Office of the County Attorney �6LW Pk�lfs Date: 8/21/2019
EAA3D33ED8A84S5..
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