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DocuSign Envelope ID: FFF24A59-BA65-479A-B4C4-5483423483E9 <br /> DS <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: FloorChem,Inc Party/Vendor Contact Person: Anita M.Brack,Owner Contact Phone: 919-854- <br /> 9776 Party/Vendor Address: 200 Powell Drive, Ste 103 City Raleigh State: NC Zip: 27606 Department: Asset <br /> Management Services Amount: 9380 Purpose: Install epoxy flooring at the Sheriffs Office Budget Code(s): <br /> 10240320-570001 Vendor# 57002 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br /> Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 10101115 Approved by Board Yes❑No <br /> ❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> 5y;uSigned bDepartment Director's Signature �OfN?nOf1 Date: 10/5/2015 <br /> 9E880A46CF64498... <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 Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned""by: <br /> ''� <br /> Office of the Risk Management Officer QUSa. (hVV,&b Date: 10/5/2015 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> ---DocuSigned by:: '' <br /> Office of the Chief Financial Officer rNAL l(fbin, Date: 10/7/2015 <br /> 232DFFC2CFA847B... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Signed by: <br /> Office of the County Attorney 56Z, otxfs Date: 10/7/2015 <br /> EAAMKEMA8465... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@oran e� countync.gov <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 />