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DocuSign Envelope ID:94E07DAC-9000-4DE4-88D2-16ED6424D6FC <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Statler Gilfillen architect-statler @outlook.com Party/Vendor Contact Person: Statler Gilfillen <br /> Contact Phone: 919-732-6123 Party/Vendor Address: 3302 St. Mary's Road City Hillsborough State: North Carolina <br /> Zip: 27278 Department: AMS Amount: $570.00 Purpose: Study of construction methods and materials comparison <br /> Budget Code(s): 10240320-570000 Vendor# 63294 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ <br /> No Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date 2/9/17 Approved by Board <br /> Yes❑No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: <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 /> oos�gea ey: <br /> Qlisa(01W-to 1/31/2017 <br /> Office of the Risk Management Office 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 /> �—oos�gea ey: <br /> Office of the Chief Financial Officer el" __ Date: 2/6/2017 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> �—oos�gea ey: <br /> ,)o(un,roknts 2/6/2017 <br /> Office of the County Attorney, �.o___ Date: <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 4 <br />