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DocuSign Envelope ID: BDD226D4-62AD-40CB-ACDA-B1D18954D81A <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Tile Restoration Inc Party/Vendor Contact Person: Brad Albritton Contact Phone: 866-327-4600 <br /> Party/Vendor Address: 119 East Main Street City Hookerton State: NC Zip: 28538 Department: AMS Amount: <br /> $3450 Purpose: Cedar Grove SaniGLAZE Restrooms 114 and 115 Budget Code(s): 10240520-630000 Vendor # <br /> 61702 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New <br /> Renewal❑ Amendment ❑ Effective Date 04/11/2016 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form ed by: <br /> Department Director's Signature <br /> Date: 4/8/2016 <br /> 9E880A46CF64498... <br /> Information Technolosies <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 i � i Wds, specifications,and requirements: <br /> Office of the Risk Management Officer Q�SA �,Orv�u16 Date: 4/8/2016 <br /> 7FDCF91 6800498... <br /> Financial Services <br /> This instrument has been pre-audited in the ma tg6g'X&O,,py the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: 11/5/15 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form anWj6jqw�y. <br /> Office of the County Attorney ,66, r6u s Date: 4/11/2016 <br /> EAA3D33EDSA8465... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.Rov <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 1/16 4 <br />