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Revised 10/17 6 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br /> <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: BIRS Party/Vendor Contact Person: Matthew French (matthew@birsroofing.com) Contact <br />Phone: 336.574.3060 Party/Vendor Address: 207 Robbins St City Greensboro State: NC Zip: 27416 Department: <br />AMS Amount: $3100.00 Purpose: Whitted Building A&B repair blisters on roofs to avoid potential cracks and <br />leaks Budget Code(s): 61370035-882000-30002 Vendor # 57369 (N/A if new vendor) Vendor is a BOCC <br />consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date <br />1/2/2018 Approved by Board Yes No Agenda Date: <br /> <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <br /> <br />Asset Management <br /> <br />(Applicable only to construction contracts) This agreement has been reviewed and is approved as to construction <br />services content and specifications: <br /> <br />Office of the Asset Management Director__________________________________ Date: ________ <br /> <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <br />Received for record retention: <br />All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <br /> <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br /> <br />DocuSign Envelope ID: 35C3F1DF-FF21-4D08-9BF4-47BAE013F645 <br />12/23/2017 <br />12/23/2017 <br />12/28/2017 <br />1/2/2018 <br />1/2/2018