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DocuSign Envelope ID: 15DD2190-46C0-4772-9B3A-17E98BAC1E66 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: 51' Wall Building Diagnostic Consultants Party/Vendor Contact Person: Jeff Spady <br /> (5thwall&bellsouth.net) Contact Phone: 919.616.4715 Party/Vendor Address: 9601 Baileywick Road City Raleigh <br /> State: NC Zip: 27615 Department: AMS Amount: $1,400.00 Purpose: Roof repairs Budget Code(s): 61370035- <br /> 880000-30002 Vendor# 58369 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: <br /> (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 11/29/16 Approved by Board Yes❑ No[] <br /> Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> D Sg tlby. <br /> Department Director's Signature Date:y,Q„ 12/1/2016 <br /> Information Technolosies <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 /> D Sg tlby. <br /> Office of the Risk Management Officer&OL (hnuN Date: 12/2/2016 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> D Sg tlby. <br /> 12/2/2016 Office of the Chief Financial Officer Date: <br /> 3E4 ESt&ift6G-1-088.. <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> r6Nty{,,,6 <br /> 0 Sg tlby. <br /> � <br /> Office of the County Attorney Date: 12/2/2016 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.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 />