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DocuSign Envelope ID: 1 E463956-EA9F-49E5-80F3-FE5F52A5605F <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> ........... <br /> Department <br /> Party/Vendor Name: Advanced Sealcoating, Inc Party/Vendor Contact Person: Dan Stark Contact Phone: 919- <br /> 844-?257 Party/Vendor Address-, 8809 Erinsbrook Drive City Raleig State: NC Zip: 27617 Department: A 1 <br /> Amount. S,5000 Purposc: S ji ing & ciling..1hroughout CSC' per Prorip 41077 Budget Codc(s): 10240320- <br /> 570000 P0 1502067 Vendor # 59959 <br /> .......... (N/A if new vendor) Vendor is a BOCC consultant? Yes [] No❑ <br /> Contract Type,: (Check one)New Z Renewal[:] Amendment F-1 Effective Date 08/24/2015 Approved by Board <br /> Yes❑NoD Agenda Date: <br /> This agreement is approved as to tect 8/24/2015 <br /> Department Director's Signature Date: <br /> Information Technologies <br /> (Applicable onh,io hardvilarelsqftware purchases or related services)This agreement has been reviewed and is <br /> approved as to inforniation technology content.and specifications: <br /> Office of the Chief Information t ff cer Date: <br /> Risk Manav_emen <br /> This agreement is approved for sufficiency of insurance standards,,specifications,and requirements: <br /> DocuSigned by: <br /> Office of the Risk Management Officer__ (hnuN Date: 8/25/2015 <br /> ............... ............. .. <br /> �7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officer Date: 8/25/2015 <br /> Lc2al Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by, <br /> Office of the County Attorney �66, re,� Date: 8/25/2015 <br /> PEAA3D33ED8A8465... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donnal...,loydupon completion @ [:�)olloyd(i47oi-anp-ecotintvnc.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Revised 10/14 5 <br />