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<br />Revised 07/20 <br /> <br />10 <br /> <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <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/Planning Amount: $34,534, includes Site 201, 202, 203, 204 and alternate 1 Purpose: Install Bus Shelters <br />at Faucette Mills/US 70, NC 86 @ Home Depot, N Churton St at HPD, NC86 (MLK) and Homestead Road Budget Code(s): <br />61370035-880000-10062 Vendor # 66963 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract <br />Type: (Check one) New Renewal Amendment Effective Date 6/1/2021 Approved by Board Yes No <br />Agenda Date: <br /> <br /> <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 /> <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 agreement have <br />already begun or been completed please briefly describe the nature of the emergency condition that was addressed: N/A <br /> <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 /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <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 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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br /> <br /> <br />DocuSign Envelope ID: 60336781-1EC3-4B9F-B8E2-081D46278222 <br />5/18/2021 <br />5/19/2021 <br />5/21/2021 <br />5/22/2021