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DocuSign Envelope ID:4760801F-0360-474B-BOD7-OBD376DD80EC <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Statler Gilfillen Architect, MBA Party/Vendor Contact Person: Statler Gilfillen <br /> (statler&outlook.com) Contact Phone: 919.732.6123 Party/Vendor Address: 3302 St. Mary's Road City Hillsborough <br /> State: NC Zip: 27278 Department: AMS Amount: 855.00 Purpose: Design for Vestibule at Judge's chamber and Jury <br /> Room Budget Code(s): 10240320-570001 Vendor # 63294 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No[] Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 12/19/2016 <br /> Approved by Board Yes❑No[] Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature �.#7��n Date: 1/3/2017 <br /> �9EaeBA4fi6r�`4495... <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 /> Do S g tl by. <br /> Q(sa�1dly, 12/28/2016 <br /> Office of the Risk Management Officer Date: <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 /> �<, d,z <br /> Office of the Chief Financial Officer���'N Date: 12/30/2016 <br /> �QGE'^tffIYLCT4tlB... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Oowsignedl. <br /> Office of the County Attorney �6L, r6�ty s Date: 12/30/2016 <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.ny_c.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 />