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DocuSign Envelope ID:2BBAA47C-8833-44D1-93B9-43EOEOA7B240 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: ASJ Wilson Construction LLC. Party/Vendor Contact Person: Michael R. Phillips (asilmichael(a^gmail.com) <br /> Contact Phone: 336.272.7122 Party/Vendor Address: 415 Pisgah Church Road, PMB 128 City: Greensboro State: NC Zip: 27455 <br /> Department:AMS Amount: Increase contract from$130,935 to$133,272 by adding$2,837.00 to existing contract Purpose: Board <br /> of Elections—Provide and install (3)Well points Budget Code(s): 61370035-880000-10008 Vendor# 66963 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal ❑ Amendment ® Effective Date <br /> 4/16/2021 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has <br /> not been initiated prior to execution of the agreement: <br /> D S11 gby: <br /> Department Director's Signature[�^a Date: 4/21/2021 <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have <br /> already begun or been completed please briefly describe the nature of the emergency condition that was addressed: NA <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to <br /> information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> D Sig g by: <br /> Office of the Risk Management Office aGsa(ann�$e Date:4/21/2021 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> P( D g.by: <br /> Office of the Chief Financial Officer �"" Date:4/27/2021 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> D Sig—by: <br /> Office of the County Attorney LOS Z R M, Date:4/28/2021 <br /> acscscoD�ce_. <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 <br />