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DocuSign Envelope ID: 098EB4F2 -C3F4- 4867- B5FC- 1 14E7E9097CF <br />ORANGE COUNTY — DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: Tile Restoration Inc Party /Vendor Contact Person: Brad Albritton Contact Phone: 252- 916 -2045 <br />Party/Vendor Address: 119 East Main Street City Hookerton State: NC Zip: 28538 Department: Asset Management <br />Services Amount: $3,535 Purpose: floor restoration in Whitted Building B Dental Clinic Restrooms Budget Code(s): <br />10240520- 630000 Vendor # 61702 (N /A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br />Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 10/31/2014 Approved by Board Yes❑ <br />No❑ Agenda Date: <br />This agreement is approved as to technical form and content: <br />DocuSigned by: <br />Department Director's Signature 5; no <rdlow Date: 10/31/2014 <br />9EHOA46CF64498... <br />Information Technologies <br />(Applicable only to hardware /software purchases or related services) This agreement has been reviewed and is <br />approved as to information technology content and specifications: <br />Office of the Chief Information Officer <br />Risk Management <br />Date: <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />DocuSig d by: <br />Office of the Risk Management Officer a�tSa reVtn t}b Date: 10/31/2014 <br />Financial Services <br />This instrument has been pre- audited in the Ana�ne� yrequired by the Local Government Budget and Fiscal Control Act: <br />�` R^'�^ 10/31/2014 <br />Office of the Chief Financial Officer ���666 Date: <br />ezEee4c�eaaa... <br />Letial Services <br />This agreement is approved as to le a� fo ndgnd sufficiency: <br />Office of the County Attorney PkA Date: 10/31/2014 <br />C- Fh3D33ED2r59A65 <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd a,oran eg countync.g_o_v <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br />DocuSigned by: <br />Office of the Clerk to the Board 106va&A 64W Date: 11/2/2014 <br />7E61 B3FC087B4DE.. <br />Revised 10/14 4 <br />