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DocuSign Envelope ID:2D2FC031-D998-499D-8152-4D0C1 B8B6D3D <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Riley Surveying, P.A. Party/Vendor Contact Person: Phillip W. Riley <br /> (Philr@rileysurveyingpa.com) Contact Phone: 919.667-0742 Party/Vendor Address: 3326 Durham Chapel Hill Blvd <br /> Ste.B-100 City Durham State:NC Zip: 27707 Department: AMS Amount: $1,200.00 Purpose: Board of Elections- <br /> provide field measures and computations for the FEMA certification to obtain flood plain information for moving the <br /> HVAC and Electrical Equipment above flood plain. Budget Code(s): 61370035-880000-10008 Vendor# 52775 (N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New ® Renewal ❑ <br /> Amendment ❑ Effective Date 9/12/17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature � w Date: 8/31/2017 <br /> P F449A <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 /> ( ousignetl by <br /> Office of the Risk Management Office T a('6 vtiuff6 Date:8/31/2017 <br /> Financial Services <br /> o; This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> l Office of the Chief Financial Office el" 'A 4°°" ' Date: 9/1/2017 <br /> Q-0,78 <G14Q9.. <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney 9o " b s Date: 9/1/2017 <br /> � <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 2/17 5 <br />