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DocuSign Envelope ID: C5B8B85E-6DD1-43B0-8A3D-A46835EB2CE7 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Statler Gilfillen Party/Vendor Contact Person: Statler Gilfillen Contact Phone: 919-732-6123 <br /> Party/Vendor Address: 3302 St Mary's Road City Hillsborough State: NC Zip: 27278 Department: AMS Amount: <br /> $3650 Purpose: Bd of Electrions Storage Upfit Design Budget Code(s): 61370035-880000-10042 Vendor # 63294 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New® Renewal <br /> ❑ Amendment ❑ Effective Date Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and coldoeT�lStf igne d by: <br /> Department Director's Signature 7 Date: 1/28/2016 <br /> 9E880A46CF64498... <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of i 79�S-O--' <br /> (2t"ards, specifications,and requirements: <br /> r,Orv�,c,�16 1/28/2016 <br /> Office of the Risk Management Officer 6�0498 Date: <br /> Financial Services <br /> This instrument has been pre-audited in the Ng-Wirgo by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer �" `�"� Date: 1/31/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and W fUmc,*: <br /> Office of the County Attorney Date: 2/2/2016 <br /> EAA3D33EDSA8465... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dollod(cr�,oran eg countyac og_v <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 Date: <br /> Revised 10/14 4 <br />