Orange County NC Website
Revised 06/21 <br /> <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />_____________________________________________________________________________________________________ <br /> <br />Party/Vendor Name: Josh Gurlitz Architecture Party/Vendor Contact Person: Josh Gurlitz Contact Phone: 919-929-7595 Party/Vendor Address: 308 <br />West Rosemary Street City Chapel Hill State: NC Zip: 27516 Department: AMS Amount: $4000.00 Purpose: Additional Services for the renovation <br />at 308 West Franklin Street, Chapel Hill Budget Code(s): 37600530-803000 Vendor # 65998 (N/A if new vendor) Vendor is a BOCC consultant? <br />Yes No Contract Type: (Check one) New Renewal Amendment Effective Date Approved by Board Yes No Agenda <br />Date: --- For Section XIV. c. contracts only, Approved by Board in Current FY Budget Yes No <br /> <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated <br />prior to execution of the agreement: <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 already begun or been <br />completed please briefly describe the nature of the emergency condition that was addressed: <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 />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 />DocuSign Envelope ID: 4678102C-951F-4651-87C1-F4A98A063D82 <br />1/7/2022 <br />1/10/2022 <br />1/10/2022 <br />1/10/2022