HomeMy WebLinkAboutR 2019-672 AMS - Fossil Group underground lines locate DocuSign Envelope ID:4813FED11-FCD9-49D7-81AD-DC7FF583EBC2
ORANGE COUNTY-DEPARTMENT USE ONLY
Party/Vendor Name: Fossil Utility Group, Inc Party/Vendor Contact Person: Doug Willis Contact Phone: 336-232-
8970 Party/Vendor Address: 5132 Bartholomews Lane City Greensboro State: NC Zip: 27407 Department: AMS
Amount: $1500 Purpose:Animal Services Locating Budget Code(s): 10240320-630000 Vendor#60548 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ❑
Amendment ❑ Effective Date 08/20/19 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:
E
ocu5igned by: 1�0
Department Director's Signature kmA Date: 9/26/2019
Agreements for emergency services or refo❑sc❑aesls4ac5. o 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: Efforts were made to place the vendor under contract. Less than a week before the larger project was to
begin,the contractor determined that he had issued the wrong quote and would need to requote the job. Based on the
importance of the overall project to Animal Services,which involved switching the utility service of the building from
one source to another,a decision was made to move forward without a contract.
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 insurance standards,specifications,and requirements:
DocuSigned by:
Office of the Risk Management Officer aUsa LQwu 6 Date: 9/26/2019
7F,CF9176800498.
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Financial Services Ep
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 Date:
9/26/2019
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7NE5181ACC1409.
Leual Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney �6� K6kk 5 Date:9/27/2019
EAA3D33ED8AW5..
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