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DocuSign Envelope ID:C3BC20BE-4177-4E09-B25F-8E12C5916446 <br /> GRANGE COUNTY-DEPARTMENT USE ONLY <br /> PartyNendor Name: BIRS, Inc PartyNendor Contact Person: Mike McClure Contact Phone: 336-574-3060 <br /> PartyNendor Address:PO Box 36197 City Greensboro State:NC ;Gip:27416 Department: AMS Amount: $1351.05 <br /> Purpose: Skills Roof Budget Code(s): 10240320-570000 Vendor#57369 (NIA if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal❑ Amendment ❑ Effective Date 2/26/19 <br /> Approved by Board Yes❑Non Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been iiiitiated prior to execution of the agreement: <br /> DocuSigned by: <br /> Department Director's Signature Qom. PbV*� Date: 3/5/2019 <br /> Agreements for emergency services or repair are not su ject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that was <br /> addressed: Emergency roof leak repair for Skills. <br /> Information Technologies <br /> (Applicahle only to hardwarelrofnvar•e 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 itI <br /> DocuSigned by: eclficatlons,and requirements: <br /> US66 (,bV1n.t,{�6 3/5/2019 <br /> Office of the Risk Management Officer 7FDCF917e800498. Date: _ <br /> Financial Services <br /> This instrument has been pre-audited in the DocuSigned by: ocal Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: 3/6/2019 <br /> 7D4E51S1ACC1409. <br /> Leval Services <br /> This agreement is approved as to legal fC�6�� <br /> DocuSigned by: <br /> Office of the County Attorney EAA=ED8A8 K6�t,V�S 405.. Date'3/6/2019 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@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 12/18 4 <br />