HomeMy WebLinkAboutR 2019-575 AMS - Hepaco courthouse stormwater cleanout DocuSign Envelope ID:58936744-93CF-49DD-8E3B-8686F5361 F84
ORANGE COUNTY-DEPARTMENT USE ONLY
Party/Vendor Name: HEPACO Party/Vendor Contact Person: Joshua Johnson Contact Phone: 704-598-9782
Party/Vendor Address: PO Box 26308 City Charlotte State: NC Zip: 28221 Department: AMS Amount:
6 250.00 Purpose: Courthouse Storm Water Clean out Budget Code(s): 10240320-570000 Vendor#63505 (N/A
if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal ❑
Amendment ❑ Effective Date 8/30/2019 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:
DLL ..ocu''Signed by:
Department Director's Signature 12DD9CD6B81844C5_
r�- Q�► A Date: 8/20/2019
Agreements for emergency services or repair are not suuject 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 insurar^-coccus 9n aby`:---;f cations,and requirements:
Office of the Risk Management Officer �US66 (,6_ 6 Date:8/23/2019
7FDC F91 768004M
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer 7❑4E5181ACC1409. Date: 8/23/2019
Legal Services
This agreement is approved as to legal form an' ---o`cuSigned by:
Office of the County Attorney �EAMD33EMAW5_
6LW Pkk , 5 Date:8/26/2019
.
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
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