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DocuSign Envelope ID:321E16A8-FDB9-4A79-AA3C-51D3867DBOEO <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Advanced SealCoating, Inc. Party/Vendor Contact Person: Dan Stark <br /> (advancedsealcoatgatt.net) Contact Phone: 919.844.2257 Party/Vendor Address: 8804 Erinsbrook Drive City Raleigh <br /> State: NC Zip: 27617 Department: AMS Amount: $650.00 Purpose: Restripe WCOB and Libarary Parking spaces <br /> due to faded existing paint Budget Code(s): 61370035-880000-30029 Vendor#59959 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective <br /> Date 5/27/18 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 /> Q� �/anxn� <br /> Department Director's Signature[IX Date:5/22/2019 <br /> Agreements for emergency services or repair are not subject 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: No work has started. <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 /> Office of the Risk Management Office Ksx bn1t f° Date: 5/23/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Office "` Date:5/24/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney �' ��° Date:5/28/2019 <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 />