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DocuSign Envelope ID:070B6BC7-CDE2-4AO8-BE62-07FA6BFDO53B <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: ASJ Wilson Construction, LLC Party/Vendor Contact Person: Josephus Wilson Contact Phone: <br /> 336.272.7122 Party/Vendor Address: 415 Pisgah Church Road, PMB 128 City Greensboro State: NC Zip: 27455 <br /> Department: AMS Amount: $130,935.00 Purpose: Board of Elections Site Improvements Budget Code(s): 61370035- <br /> 880000-10008 Vendor#66963 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check <br /> one)New® Renewal ❑ Amendment ❑ Effective Date 1/18/2021 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this <br /> project has not been initiated prior to execution of the agreement: <br /> D s'g a by: <br /> Department Director's Signature Sf arud# 1/12/2021 <br /> �� Date: <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have <br /> already begun or been completed please briefly describe the nature of the emergency condition that was addressed: N/A <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards, specifications,and requirements: <br /> Docos�gnea by: <br /> Office of the Risk Management Officer 'Usa(,anu$e Date: 1/12/2021 <br /> ]FDCFgt]BBDD69g.. <br /> Financial Services <br /> 1Ds This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> P( 0 Sig—by: <br /> Office of the Chief Financial Officer 0" `" Date:1/1z/zozl <br /> C <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> D 5'g a by: <br /> Office of the County Attorney ;,kniv, Date 1/12/2021 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@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 07/20 10 <br />