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DocuSign Envelope ID:836A3E19-B1A7-4851-B49E-61502E03900D <br /> os <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Riley Sureying P.A. Party/Vendor Contact Person: Philip Riley Contact Phone: 919-667-0742 <br /> Party/Vendor Address: 3326 Durham Chapil Hill Blvd City Durham State: NC Zip: 27707 Department: AMS <br /> Amount: $3,200 Purpose: Surveying Work Budget Code(s): 61370035-880000-10051 Vendor# 52775 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 3/11/2019 Approved by Board Yes❑No® 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 initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> Department Director's Signature1121EFMAGD4�4EF_WPbV*�. Date:3/11/2019 <br /> Agreements for emergency services or i suoject 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: <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 /> DocuSigrneed_by: <br /> .�t <br /> Office of the Risk Management Office aUS66 (" 6 Date: 3/11/2019 <br /> 7FOCF9176800498. <br /> Financial Services <br /> This instrument has been pre-audited i 7 Docusigned by: the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Office � � 3/11/2019 <br /> D4E59S1ACC1469. Date: <br /> Legal Services <br /> This agreement is approved as t- '--U-oc'urS-ig-n--ed by:' -`ficienc : <br /> Office of the County AttorneZ�66 Pkk , 5 Date: 3/11/2019 <br /> EAA3D33ED8AW5.. <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 />