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DocuSign Envelope ID:EEC95C86-425F-4B19-8B7B-D793E7A74AE5 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: H.M Kern Party/Vendor Contact Person: Justin Graves(j aves(c4hmkern.com) Contact Phone: 336.668.3213 Party/Vendor <br /> Address: 160 Thatcher Road City Greensboro State:NC Zip:27419 Department:AMS Amount: 15,138.00 Purpose:Change Orders required due to <br /> unforseen conditions,or due to tentant requests,see attached change description details. Budget Code(s): 61370035-880000-10023 Vendor#60426 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New❑ Renewal❑ Amendment ® Effective <br /> Date 9/24/2018 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> 10owdj <br /> Department Director's Signature Qf u,` , Date:3/20/2019 <br /> Asset Management <br /> (Applicable only to construction contracts)This agreement has been reviewed and is approved as to construction services content and specifications: <br /> ­1"' <br /> Office of the Asset Management Director Date:3/20/2019 <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> Office of the Risk Management Office dLsn ianut Date:3/21/2019 <br /> Financial Services <br /> m Th;s instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> C�niJ,9lau?.)� ��9N de <br /> ""..ice of the Chief Financial Officer q 3/25/2019 <br /> Date: <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ,row <br /> Office of the CountyAttorney �°�'"f`" Date: 3/25/2019 <br /> y�,,,,N,w. <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 10/17 <br />