R 2017-505-E AMS - Statler Gilfillen Architect for drawing of house at 1127 SR70

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DocuSign Envelope ID: DE3C75A2-D215-4D84-9DF5-10E37FC04906 ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Statler Gilfillen Architect Party/Vendor Contact Person: Statler Gilfillen(Statler @outlook.com) Contact Phone: 919.732.6123 Party/Vendor Address: 3302 St. Mary's Road City Hillsborough State: NC Zip: 27278 Department: AMS Amount: $980.00 Purpose: Drawing for house at 1127 SR70 Budget Code(s): 10240320-630000 Vendor# 63294 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 8/31/17 Approved by Board Yes' No Agenda Date: This agreement is approved as to technical form and content: Department Director's Signature w Date: 8/31/2017 -FLUnn4e°"^"' Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: Qlisa 6ortalfo 9/5/2017 Office of the Risk Management Office „ Date: Financial Services OS l "i5 This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer '� Date: 9/7/2017 Arr 1494 Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney )0t �0�``�s Date: 9/8/2017 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 2/17 5