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DocuSign Envelope ID:4B278511-4170-44D5-BDD9-OAE98C5E8FAE <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: W.L.Bishop Party/Vendor Contact Person: Jerry Smith Contact Phone: 919-732-2546 <br /> Party/Vendor Address: 2211 Leah Dr, Suitel City Hillsborough State: NC Zip: 27278 Department: DEAPR <br /> Amount: 19,3888.00 Purpose: Asphalt paving_ Budget Code(s): 61370035 880000 20027 Vendor#059867 (N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal❑ <br /> Amendment ❑ Effective Date March 21,2016 Approved by Board Yes[]No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSIignedby: <br /> Department Director's Signatur Via Sl 1 at"'a Date: <br /> 611CFA1D507A495... 3/11/2016 <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 insurance standards,specifications,and requirements: <br /> DocuSigned by: <br /> '�.�. <br /> Office of the Risk Management Officer Faus. ch"tt,�16 _ Date: <br /> 7FDCF9176800498... 3/14/2016 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Office �� 0 . Date:X16 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ocuSigned by:,'��,, <br /> Office of the County Attorney EjEAA3D33ED8A8465...6LVt, r6ufs Date: <br /> 3/17/2016 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd cz ora�nnc. ov <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 1/16 5 <br />