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DocuSign Envelope ID:A933F1D1-BB8A-4AA6-BA5B-85764B946906 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Statler Gilfillen Architect MBA Party/Vendor Contact Person: Stater Gilfillen Contact Phone: <br /> 919-732-6123 Party/Vendor Address: 3302 St Mary's Road City Hillsborough State: NC Zip: 27278 Department: <br /> AMS Amount: $500 Purpose: Mods to Whitted Room 210 Budget Code(s): 61370035-87000-10052 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 03/28/2016 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical fo5i;rBi aqd cg ptcnt: <br /> Department Director's Signature Ao jxo°"' Date: 3/19/2016 <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 insurance standards, specifications,and requirements: <br /> IDocu5igned""by:'�� <br /> Qusa, rbrwc 6 3/21/2016 <br /> Office of the Risk Management Officer Date: <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner recd ire4 by the Local Government Budget and Fiscal Control Act: <br /> oc igne by: <br /> Office of the Chief Financial Officer 3/23/2016 <br /> Fel�� s�oraR,�losz Date: <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufAgiQ evd'by. <br /> �bU In, <br /> Office of the County Attorney Date: 3/24/2016 <br /> EAA3D33ED8A8465... <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 1/16 4 <br />