HomeMy WebLinkAboutR 2018-740 Planning - NC DEQ financial responsibility form l
ORANGE COUNTY- --DEPARTMENT USE ONLY---HARD COPY ONLY
Department
Party/Vendor Name : NCDEQ Party/Vendor Contact Person : Christopher J . Sandt, P . E . , Staff Engineer
Contact Phone : 919 -245 -2583 Party/Vendor Address : 3800 Barrett Drive City Ralei State : NC Zip . 27609
Department : Planning Amount : $ 520 associated NCDEQ application fee) Purpose : NEED COUNTY MANAGER
SIGNATURE ON REVISED FINANCIAL RESPONSIBILITY/OWNERSHIP FORM FOR NCDEQ EROSION
AND SEDIMENT CONTROL PERMITTING OF THE MLLSBOROUGH AREA EDD WATER AND SEWER
EXTENSION PROJECT Budget Code(s) : 61370035 - 850000 -30048 Vendor #N/A (N/A if new vendor) Vendor
is a BOCC consultant? Yes ❑ No ® Contract Type : (Check one) New ❑ Renewal ❑ Amendment ❑
Effective Date July 9 , 2018 Approved by Board Yes ❑ No ® Agenda Date :
This agreement is approved as to technical fo and conten .
Department Director ' s Signature Date : w
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 :
Office of Risk Management � � C .� � r Date .
Financial Services
This instrument has been pre- audited in the er equir d by the Local Government Budget d Fiscal Control
Act .
Office of the Chief Financial Officer Date : L /
Legal Services
This agreement is approved as to legal form and fficie c
Office of the County Attorney Date . /Q
Clerk to the Board
Received for record retention :
Office of the Clerk to the Board Date .
Revised 10/ 17
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