HomeMy WebLinkAboutR 2020-144 AMS - Summit Engineering OPT Sewer tie in DocuSign Envelope ID:86AA2D69-2618-49CA-ABD9-3717E162CF6E
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Summit Design and Engineering Services PLLC Party/Vendor Contact Person: Don Server,PE
Contact Phone: 919.732.3883 Party/Vendor Address: 320 Executive Court City Hillsborough State: NC Zip: 27278
Department: AMS Amount: $4,200 Purpose: Orange County Puclic Transportation Admin Sewer tie in to TOH
Budget Code(s): 61370035-870000-10075 Vendor# 53403 (N/A if new vendor) Vendor is a BOCC consultant?
Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 02/20/2020
Approved by Board Yes❑No® Agenda Date:N/A
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 Signatur QV1n'� Date2/19/2020
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: N/A
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 sufficient Wocusigned by: ' rds,specifications,and requirements:
c,USX (ham 6 2/19/2020
Office of the Risk Management Office Date:
7FDCF91788a049S...
Financial Services
Ds This instrument has been pre-audited i ' DocuSigned by: the Local Government Budget and Fiscal Control Act:
�L office of the Chief Financial Office 4 Date: 3/12/2020
704E51S1ACC1409...
Legal Services
This agreement is approved as t ' D�tocu,,SSigned by:' 11 ciency:
Office of the County Attorney 6%f`', hmv, Date: 3/12/2020
14C5F3CDDFOB94F8...
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 11/19 4