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ORANGE COUNTY—DEPARTMENT USE ONLY <br />_____________________________________________________________________________________________________ <br />Party/Vendor Name: WB Brawley Company Party/Vendor Contact Person: Jeremy Thompson Contact Phone: 919-636-1338 Party/Vendor Address: <br />5121 Kingdom Way, Suite 305 City Raleigh State: NC Zip: 27607 Department: AMS Amount: -$841.81 Purpose: WCOB 3rd floor Renovation, Credit <br />for Wallcovering Budget Code(s): 61370035-880000-10078 Vendor # 67616 (N/A if new vendor) Vendor is a BOCC consultant? Yes No <br /> Contract Type: (Check one) New Renewal Amendment Effective Date Approved by Board Yes No Agenda Date: <br />--- For Section XIV. c. contracts only, Approved by Board in Current FY Budget Yes No <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 />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 />Risk Management <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />Office of the Risk Management Officer___________________________________ Date: _________ <br />Financial Services <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________Date: ________ <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 06/21 <br />DocuSign Envelope ID: D704809F-D65E-4E2D-9B85-B21A752AFDFE <br />12/28/2022 <br />1/6/2023 <br />1/6/2023