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Revised 11/19 <br />9 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: Smith Sinnett Architecture, P.A. Party/Vendor Contact Person: Drew Wilgus <br />(dwilgus@smithsinnett.com) Contact Phone: 919.781.8582 Party/Vendor Address: 4600 Lake Boone Trail, Ste 205 <br />City Raleigh State: NC Zip: 27607 Department: AMS Amount: NTE $45,540 (Design $36,900, Reimbursables <br />$5,940.00) Purpose: Southern Human Services Building - Connections for Mobile Dental Clinic Budget Code(s): <br />61370035-870002-10065 Vendor # 64733 (N/A if new vendor) Vendor is a BOCC consultant? Yes No <br />Contract Type: (Check one) New Renewal Amendment Effective Date 1/25/2020 Approved by Board <br />Yes No Agenda Date: <br /> <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 /> <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <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 /> <br />Information Technologies <br /> <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 /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br /> <br />DocuSign Envelope ID: 10A85B79-5184-4395-AE79-413DB1556EEE <br /> <br /> <br /> <br />