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DocuSign Envelope ID:5B46C8FA-F9AB-4AOA-9FO8-7135E13A4E52 <br /> GRANGE COUNTYY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Robert S. Jones and Associates Party/Vendor Contact Person: JD Cecil Contact Phone: 919 <br /> 563-3623 Party/Vendor Address: 201 W. Clay Street City Mebane State: NC Zip: 2.7302 Department DEAPR <br /> Amount: $1,240 Purpose: Survey of site of original historic Harvey's Chapel and old cemetery at Seven Mile Creek <br /> Budget Code(s): 61370035 899950 20006 Vendor# 57711 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ NoE Contract Type: (Check one)New 0 Renewal ❑ Amendment ❑ Effective hate October 22,2018 <br /> Approved by Board Yes❑NoZ Agenda Date:N/A <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature FOAVt, `A,I&U Da Le: 10/30/2018 <br /> 611 CFA1 D507A495... <br /> Information Technologies <br /> (Applicable only to hardwarelsoftrvare 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 Manadernent <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned__by: <br /> ""� <br /> Office of the Risk Management Officer F&A, v1A.�,1(b Date: 10/31/2018 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer Date: 11/1/2018 <br /> 7D4E5181ACC1409... <br /> Lep_al Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney a►MGS bnINA, Date: 11/2/2018 <br /> EA328DC480549A4F5 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri ingersoll upon completion: singersoll(@,orangecountvnc.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 10117(Mgr appry 5k 6118) 4 <br />