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Revised 07/20 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: ASJ Wilson Construction LLC. Party/Vendor Contact Person: Michael R. Phillips (asj1michael@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 $134,184 to $141,437.15 by adding $7253.15 to existing contract <br />Purpose: Board of Elections – Provide additional brick pavers to complete entrance walkway. Budget Code(s): 61370035-880000- <br />10008 Vendor # 66963 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New <br />Renewal Amendment Effective Date 8/20/2021 Approved by Board Yes No Agenda Date: <br /> <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 /> <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: NA <br /> <br />Information Technologies <br /> <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 /> <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 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 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 />DocuSign Envelope ID: CA949BE9-C4E1-4240-9F98-AFB8F9A022BC <br />8/23/2021 <br />8/23/2021 <br />8/24/2021 <br />8/24/2021