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DocuSign Envelope ID: F8057E6E-3837-4DFE-AEF9-BD8F83298798 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> PartyNendor Name: Riley Surveying P.A. Party/Vendor Contact Person: Jose Torres Contact Phone: 919-667-0742 <br /> Party/Vendor Address: 3326 Durham Chapel Hill Blvd Suite B-100 City Durham State:NC Zip: 27707 Department: <br /> DEAPR Amount: $3,500 Purpose: Togo Survey work Budget Code(s): 61370035 860000 20003 Vendor# 52775 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal <br /> ❑ Amendment ❑ Effective Date 4/12/19 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 Signatu rum' Date: 4/15/2019 <br /> Agreements for emergency servicf a w,5 I;a;.°�'V:;,,,object 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 Technoloizies <br /> (Applicable only to hardwarelsofhvare 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 /> DocuSigned_by: i�tt <br /> Office of the Risk Management Office && c bvw lib Date:4/17/2019 <br /> 7FDCF9176900498. DS <br /> Financial ServicesIr <br /> F <br /> This instrument has been pre-audited *pocu5igned dy"�"''"�'`'y the Local Government Budget and Fiscal Control Act: <br /> 4/18/2019 <br /> Office of the Chief Financial Office '� UaEc: <br /> 7D4E51S1ACC1409. <br /> Legal Services <br /> This agreement is approved as—'­iiocusifined --1"'•fficiency: <br /> Office of the County Attorne �66A, K6ku'6 Date: 4/22/2019 <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 />