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DocuSign Envelope ID:8CFODBE7-8B79-49E2-92BC-06D4EO10765E <br /> os <br /> ORANGE COUNTY—DEPARTMENT USE ONLY Qi <br /> Party/Vendor Name: Riley Surveying P.A. Party/Vendor Contact Person: Phil Riley Contact Phone: 919-667-0742 <br /> Party/Vendor Address: 3326 Durham Chapel Hill Blvd, Ste B-100 City Durham State: NC Zip: 27707 Department: <br /> AMS Amount: $1170 Purpose: Battle Court Roof Budget Code(s): 61370035-882000-30002 Vendor# 52775 (N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 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 /> UocuSigned by: <br /> q� <br /> Department Director's Signature �W PbV*aaA. Date: 5/7/2019 <br /> Agreements for emergency services or rep, 21EFMACD454EF.. he 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: This work was approved by the former Asset Management Services Director,and funding advice was <br /> finalized 03/20/19 by new director for CIP. <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 /> DocuSigned_by:. <br /> Office of the Risk Management Officer 9Usa ('6 6 Date: 5/7/2019 <br /> 7FOCF9176800498. DS <br /> Financial Services Ir <br /> L <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer � '� '� Date: 5/8/2019 <br /> 7NE5181 ACC 1400- <br /> Legal Services <br /> This agreement is approved as to legal forr- ^—Uoeusigned by, <br /> Office of the County Attorney �6LW Pkk�s Date: 5/8/2019 <br /> EAA3MaEMA905.. <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 />