HomeMy WebLinkAboutR 2019-157 AMS - Riley Surveying Holloway property DocuSign Envelope ID:836A3E19-B1A7-4851-B49E-61502E03900D
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ORANGE COUNTY-DEPARTMENT USE ONLY
Party/Vendor Name: Riley Sureying P.A. Party/Vendor Contact Person: Philip Riley Contact Phone: 919-667-0742
Party/Vendor Address: 3326 Durham Chapil Hill Blvd City Durham State: NC Zip: 27707 Department: AMS
Amount: $3,200 Purpose: Surveying Work Budget Code(s): 61370035-880000-10051 Vendor# 52775 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑
Amendment ❑ Effective Date 3/11/2019 Approved by Board Yes❑No® Agenda Date:
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 prior to execution of the agreement:
DocuSigned by:
Department Director's Signature1121EFMAGD4�4EF_WPbV*�. Date:3/11/2019
Agreements for emergency services or i suoject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that was
addressed:
Information Technologies
(Applicable only to hardware/software 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:
DocuSigrneed_by:
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Office of the Risk Management Office aUS66 (" 6 Date: 3/11/2019
7FOCF9176800498.
Financial Services
This instrument has been pre-audited i 7 Docusigned by: the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Office � � 3/11/2019
D4E59S1ACC1469. Date:
Legal Services
This agreement is approved as t- '--U-oc'urS-ig-n--ed by:' -`ficienc :
Office of the County AttorneZ�66 Pkk , 5 Date: 3/11/2019
EAA3D33ED8AW5..
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 12/18 4