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DocuSign Envelope ID: F2CFCEDE-82B3-4468-95F8-FDB924COC618 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: 5h Wall Building Diagnostics Consultants, LLC Party/Vendor Contact Person: Jeff Spady <br /> (jeffa,5thwallbdc.com) Contact Phone: 919.616.4715 Party/Vendor Address: 9601 Baileywick Road City Ralei <br /> State: NC Zip: 27615 Department: AMS Amount: $1,400.00 Purpose: Construction Admin for Historic Courthouse <br /> Roof&Gutter Repairs Budget Code(s): 61370035-882000-30002 Vendor#58369 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date <br /> July 25,2016 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> D 5 g d by: <br /> Department Director's Signature - _ Date: 7/21/2016 <br /> Information Technologies <br /> (Applicable only to harchvare/sofnvare 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 /> D Sy dby: <br /> lL(sa �awLCffa <br /> Office of the Risk Management Office Date: 7/21/2016 <br /> FoeFg+�Eeao i_a <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> Doc Sig ed by <br /> Office of the Chief Financial Officer <br /> ' _& Date: 7/22/2016 <br /> �2l.Csiv.hcCa%y <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> D S g dby: <br /> 66 �eti�s <br /> Office of the County Attorney Date: 7/22/2016 <br /> �'FAA3fT.s3FthSR8f65... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <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 6/16 5 <br />