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DocuSign Envelope ID: B2AEF412-BOEF-459E-B763-A53572F54A27 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> ..._w......._......._...................................... ..........._ ............................................ <br /> Department <br /> Party/Vendor Name: 5th W I Buildjnig_j2Ltag <br /> �Tjqsf <br /> -al �b s Consultants Party/Vendor Contact Person: Jeff Spad Contact <br /> Phone: 919-6164715 Party/Vendor Address: 9601 <br /> L_ Baileywi�k Rd... City Raleigh State: NC Zip: 27615 Department:: <br /> AMS Amount: Ll 5 7.00 Purpose: general consulting sgry�jcesfor the lortico Structural Restoration of the ()ran,, <br /> County Magistrates' Office roof Budget Code(s): 10240�320-57000 l. Vendor# 58369 (N/A if new vendor) Vendor <br /> is a BO CC consultant? Yes El No Contract Type: (Check one) New r,71 Renewal r-I Amendment El Effective <br /> Date Approved by Board YesFj No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature___ Date'. 6/26/2015 <br /> Information Technologies <br /> (Applicable only to harclwarelsof1ware purchases or related services)This agreenient has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer )date: <br /> Risk Manauernent <br /> This agreement is approved for sufficiency of insurar6g,�,VQ6�ds,specifications,and requirements: <br /> u , ne : <br /> Office of the Risk Management Officer US& (t b Date: 6/27/2015 <br /> QMZP91799_04_99­ ..-. ............. <br /> Financial Services <br /> This instrument has been pre-audited in the manner boa ire q <br /> ,g, ne <br /> 0 Ig yy the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer P4 bov 6V, Date: 6/29/2015 <br /> 232DFFC2CFA847B <br /> Ley-al Services <br /> This agreement is approved as to legal fort <br /> Office of the County Attorney Date: 6/30/2015 <br /> Clerk to the Board <br /> Received for record retention: <br /> All I Docusign contracts rnust be copied to Donna Lloyd upon completion (ii',I)o1joydf)qE. <br /> (L �jpj <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board <br /> Revised 10/14 4 <br />