R 2014-466 AMS - Tile Restoration, Inc. for WHSC initial sealing process

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EpdvTjho!Fo4 rpgf!,E;!B63G1C35.9141.51 EG9:37.4G1 4323BDl 35 ORANGE COUNTY-DEPARTMENT USE ONLY NOT A CONTRACT EXHIBIT OR ATTACHMENT Department Party/Vendor Name: Tile Restoration, Inc. Party/Vendor Contact Person: Brad Albritton Contact Phone: 252-916- 2045 Party/Vendor Address: 119 East Main Street, PO Box 160 City Hookerton State: NC Zip: 28538 Department: Asset Management Services Amount: 4580 Purpose: WHSC Initial Sealing Process Budget Code(s): 61370035- 880000-10028 Vendor#61702 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New ❑ Renewal ❑ Amendment ❑ Effective Date 08/22/2014 Approved by Board Yes❑No[-] Agenda Date: This agreement is approved as to technical form and content: E�;uSigned by: Department Director's Signature 74 v,.p" Date: 8/18/2014 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 Director of Information Technology Date: Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: DocuSigned by: Office of Risk Management gus& CbVta,t b Date: 8/18/2014 'I-7FDCF9176800498 Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: C_� Office of the Chief Financial Office � -,b Date: 8/25/2014 2F982EC44C2C444... Lejjal Services This agreement is approved as to legal fonn and sufficiency: DocuSigned by: Office of the County Attorney �66 Oufs Date: 8/26/2014 Clerk to the Board Received for record retention: DocuSigned by: EV blala,A. 15A.�t V 8/26/2014 Office of the Cleric to the Board Date: 7E61 B3FC087B4DE.. Revised 7/14 4