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DocuSign Envelope ID:453C1A54-9B45-4FE0-9E13-2B8723D592A7 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Clark Poe Construction, Inc. Party/Vendor Contact Person: F. Clark Poe Contact Phone: <br /> (919) 625-5104 Party/Vendor Address: 134 Granger Road City Chapel Hill State: NC Zip: 27516 Department: <br /> DEAPR Amount: $24,670 Purpose: Moving the historic Hollow Rock Store to the Hollow Rock Nature Park, <br /> including new foundation and associated structural work. Budget Code(s): 61370035 880000 20027 Vendor # <br /> 58637 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New <br /> Renewal❑ Amendment ❑ Effective Date September 30,2016 Approved by Board Yes❑No® Agenda <br /> Date:N/A <br /> This agreement is approved as to technical form and content: <br /> DocuSignedd by: <br /> Department Director's Signature Fva),At sfatA Date:10/3/2016 <br /> 611CFA1D507A495... <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. ,nAA 16 Date: 10/3/2016 <br /> 7FDCF9176800498... <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 Officer 0 . Date: 10/3/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> uSigned by:,',�,�,, <br /> Office of the County Attorney 56Z, r6uw s Date: 10/4/2016 <br /> EAAMKEDM8465._ <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd a,orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Revised 6/16 6 <br />