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DocuSign Envelope ID:275B3B05-B2FE-40DF-BB01-E20869774963 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: William E. Smith Masonry Inc. Party/Vendor Contact Person: Tiffany Smith Bennett <br /> (tiffanygwilliamesmithmasonry.com) Contact Phone: 513.235.5733 Party/Vendor Address: 1818 Marion Ford Road <br /> City Chapel Hill State: NC Zip: 27516 Department: AMS Amount: $1500.00 Purpose: New Court House - Safety <br /> Issue - Repair the step nose that is loose and falling apart Budget Code(s): 61370035-880000-30001 Vendor# 65715 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ® Renewal <br /> ❑ Amendment ❑ Effective Date 4/20/2020 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 /> Department Director's Signature Date: 4/17/2020 <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: 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 Ksx bml f° Date: 4/17/2020 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> PL Office of the Chief Financial Officer Date: 4/20/2020 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> 4/21/2020 <br /> Office of the County Attorney[ 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 11/19 4 <br />