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DocuSign Envelope ID: D0190336-4C5C-477F-8902-D25F819470B6 <br /> DS <br /> LI ORANGE COtATY-DEPARTMENT USE ONLY <br /> ---------------------........................................................ <br /> Devartment <br /> PartyNendor Name:: Tile Restoration Inc Party/Vendor Contact Person: Brad Albritton, Vice President Contact <br /> Phone: 866-3274600 PartylVendor Address: 119 East Main Street City Hookerton State: NC Zip: 28538 <br /> Department: Asset Management Services Amount: $6,125 Purpose: flooring restoration at 302 W ry anrt S reet, <br /> Central Rec &.Parks Center(pgj -630000 Vendor# 6170�2 (N/A if new vendor) <br /> _pj�ppLg� <br /> --- ----- ID Budget Code(s): 10240520 <br /> Vendor is a BOCC consultant? Yes E] NoZ Contract Type: (Check one) New Z Renewal ❑ Amendment El <br /> Effective Date 02/02/2015 Approved by Board Yes[]Non Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> D—Sign.d by: <br /> Department Director's Signature g.#7A.-P"- -------- . .. .... ..--.... Date: 2/6/2015 <br /> ...................................... -- ......... ............... .. --------------- <br /> 9EBBOA46CFE4492 <br /> Information TechnoloLyies <br /> (Applicable on y to hatrthvat,clsoftwarepiirci?ascry or agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications, and requirements: <br /> C D...Si,n,d by: <br /> Office of the Risk Management Officer 'US.(,6nWt6 Date: 2/8/2015 <br /> ----------- -------- <br /> 7rocrnmobng <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> [—.Si,n.d by <br /> Office of the Chief Financial Officer vu Date: <br /> 2/9/2015 <br /> Levi Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ­.Si,n.d by <br /> Office of the County Attorney .. Date: 2/9/2015 <br /> ............. <br /> Clerk to the Board <br /> Received for record retention: <br /> All DocusicyL,n contracts must be copied to Donna Lloyd upon completion Dollovd,(i�oi-a.rigecounkyjic.�-ov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/14 4 <br />