HomeMy WebLinkAboutR 2016-526-E AMS - Statler Gilfillen Architect for AE/CA services for upgrades to single ocupancy restrooms DocuSign Envelope ID:A7753E2F-4451-4192-BB5F-EF1A4DCAF8F8
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Statler Gilfillen Architect Party/Vendor Contact Person: Statler Gilfillen Contact Phone:
919.732.6123 Party/Vendor Address: 3302 St Marys Road City Hillsborough State: NC Zip: 27278 Department:
AMS Amount: $10,200.00 Purpose: AE/CA Services for Upgrades to Single Occupancy Restrooms Budget Code(s):
61370035-880000-30001 Vendor # 63294 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No®
Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 9/19/2016 Approved by Board
Yes❑No® Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature � 5 �"'°" Date: 9/12/2016
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Information Technologies
(Applicable only to hardtivarelsofhvare purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficiency of insurance standards,specifications, and requirements:
U 59 dby
Office of the Risk Management Office AUS0,(awuflo Date: 9/13/2016
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Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
U 59 dby:
Office of the Chief Financial Officer Date: 9/13/2016
Legal Services
This agreement is approved as to legal form and sufficiency:
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Office of the County Attorney 966u r6uw s Date: 9/15/2016
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Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov j
The following signature block is for hard copies only and is not required for Docusign contracts:
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Office of the Clerk to the Board Date:
Revised 6/16 5