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DocuSign Envelope ID:460EC398-6CEE-4CAF-831A-1D646823727C <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> NOT A CONTRACT EXHIBIT OR ATTACHMENT <br /> Department <br /> Party/Vendor Name: Cruz Concrete Experts, LLC Party/Vendor Contact Person: Demetrio Cruz, Owner Contact <br /> Phone: 336-736-0520 Party/Vendor Address: 800 Linens Street City Graham State: NC Zip: 27253 Department: <br /> Asset Management Services Amount: $2,000 Purpose: RENA Community Center - labor to install Basketball Court <br /> Budget Code(s): 61370035-880000-10054 Vendor# 62662 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 10/01/2014 <br /> Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> �i <br /> Department Director's Signature r /b /y I Date: t <br /> t <br /> `Information TechpSfogies <br /> (Applicable only to hardware/software purchases or rlejateyi services)This agreement has been reviewed and is <br /> approved as to information technology content and spcations: <br /> Office of the Director of Information Technology N„ Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> du. <br /> Office of Risk Management use (a�b Date: 10/3/2014 <br /> ircc rxi iuwiuvaa... <br /> Financial Services <br /> This instrument has been pre-audited in the manner reauired by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by. <br /> Office of the Chief Financial Officer_ I �� .bm Date: 10/6/2014 <br /> PFr96=44C2C444... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> D—Signed by <br /> Office of the County Attorney[EAUD33ED9AZ465�� b�ts Date: 10/6/2014 <br /> .. <br /> Clerk to the Board <br /> Received for record retention: <br /> D—Signed by <br /> Office of the Cleric to the Board bv," b4W Date: 10/7/2014 <br /> 7ES133FGG57B4DE... <br /> I <br /> Y <br /> Revised 7/14 4 <br />