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DocuSign Envelope ID:4760801F-0360-474B-BOD7-OBD376DD80EC <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Statler Gilfillen Architect, MBA Party/Vendor Contact Person: Statler Gilfillen <br /> (statler(a,outlook.com) Contact Phone: 919.732.6123 Party/Vendor Address: 3302 St. Marys Road City Hillsborough <br /> State:NC Zip: 27278 Department: AMS Amount: 855.00 Purpose: Design for Vestibule at Judge's chamber and Jury <br /> Room Budget Code(s): 10240320-570001 Vendor# 63294 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 12/19/2016 <br /> Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Wwi9lgned ly: <br /> Department Director's Signature Date: 1/3/2017 <br /> arw:••Fecr�aa�... <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 /> Office of the Risk Management OfficeQCisa bnu.,t Date: 12/28/2016 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> w signed ur. <br /> 12/30/2016 <br /> Office of the Chief Financial Officer I <br /> Date: <br /> CNG'61/.C�14P1... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> �� d bY; 12/3 0/2 016 <br /> C°6,x4Ig�,e <br /> Office of the County Attorney Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync.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 5 <br />