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DocuSign Envelope ID:A7753E2F-4451-4192-BB5F-EF1A4DCAF8F8 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Statler Gilfillen Architect Party/Vendor Contact Person: Statler Gilfillen Contact Phone: <br /> 919.732.6123 Party/Vendor Address: 3302 St Marys Road City Hillsborough State: NC Zip: 27278 Department: <br /> AMS Amount: $10,200.00 Purpose: AE/CA Services for Upgrades to Single Occupancy Restrooms Budget Code(s): <br /> 61370035-880000-30001 Vendor # 63294 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® <br /> Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 9/19/2016 Approved by Board <br /> Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature � 5 �"'°" Date: 9/12/2016 <br /> C� <br /> Information Technologies <br /> (Applicable only to hardtivarelsofhvare 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 /> U 59 dby <br /> Office of the Risk Management Office AUS0,(awuflo Date: 9/13/2016 <br /> 0�9as.ase_ <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> U 59 dby: <br /> Office of the Chief Financial Officer Date: 9/13/2016 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> 9 <br /> Office of the County Attorney 966u r6uw s Date: 9/15/2016 <br /> �E,��9sE_a�d.,Eb_ <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 j <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> i <br /> Office of the Clerk to the Board Date: <br /> Revised 6/16 5 <br />