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DocuSign Envelope ID:9DFOE4B9-6D1E-4361-9820-05E21BC05405 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: William E. Smith Masonry, Inc Party/Vendor Contact Person: Tiffany Smith Bennett Contact <br /> Phone: 919-321-1814 Party/Vendor Address: 1818 Marion's Ford Road City Chapel Hill State: NC Zip: 27516 <br /> Department: AMS Amount: $300.00 Purpose: New Courthouse Stone Wall Cap Repair Budget Code(s): 10240320- <br /> 570000 Vendor#65715 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check <br /> one) New ❑ Renewal ❑ Amendment ❑ Effective Date 10/20/2019 Approved by Board Yes[—] No❑ <br /> 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 Signature �� 9MA Date:10/15/2019 <br /> 2DD9CD6681844C5. <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: <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 ine------D-oc-usi9ned by:'" --,cifications,and requirements: <br /> Office of the Risk Management Officer U$6. �,bVln.t,{�6 Datc:10/15/2019 <br /> 7FDCF9176800498. <br /> Financial Services <br /> This instrument has been pre-audited in the ma Docusigned by: d Government Budget and Fiscal Control Act: <br /> 10/15/2019 <br /> Office of the Chief Financial Officer 7D4E5181.acCAN. Date:_ _ <br /> Legal Services <br /> This agreement is approved as to legal form C <br /> DocuSigned by:b� Pk� 10/16/2019 <br /> Office of the County Attorney EAA3D33ED8AW5.. Date: <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 />