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DocuSign Envelope ID:9DC16EAB-77D3-4316-AF4C-969A33AE3003 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Riley Surveying P.A. Party/Vendor Contact Person: Phillip W. Riley <br /> (philr(a-)rileysurveyingpa.com) Contact Phone: (919)667-0742 Party/Vendor Address: 3326 Durham Chapel Hill <br /> Blvd. Suite B-100 City Durham State: NC Zip: 27707 Department: AMS Amount: $2450 Purpose: Efland <br /> Stand-A-Lone Topographic Survey Utility Update including septic Budget Code(s): 61370035-870000-10053 <br /> Vendor#52775 (N/A if new vendor) Vendor is a BOCC consultant? Yes ®No❑ Contract Type: (Check one) <br /> New ® Renewal ❑ Amendment ❑ Effective Date 11/l/2019 Approved by Board Yes❑No® Agenda <br /> Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> 10/23/2019 <br /> Department Director's Signature "" ���S Date: <br /> CsP <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 <br /> was addressed: N/A <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 QGs� �e���#f° Date:10/23/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Fz Act: <br /> Office of the Chief Financial Office " Date: 10/23/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney �' ` Date: 10/25/2019 <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 <br /> 8 <br />