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DocuSign Envelope ID: C057BFCE-FE50-48B8-990C-1588389F9587 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Tibbens Construction Inc. Party/Vendor Contact Person: Mark Tibbens Contact Phone: <br /> 919.643.2856 Party/Vendor Address: 849 Moose Tracks Trail City Cedar Grove State: NC Z_ ip: 27231 <br /> Department: AMS Amount: $14,365.00 Purpose: Whitted Room 210 Renovation Budget Code(s): 10240320- <br /> 570001 Vendor# 63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: <br /> (Check one)New ® Renewal ❑ Amendment ❑ Effective Date April 22, 2016 Approved by Board Yes❑ <br /> No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> D Sg tlby. <br /> Department Director's Signature � Date; 4/19/2016 <br /> �6EEIIIQ1�36'Fo3Se <br /> Information Technologies <br /> (Applicable only to harchvare/sofhvare pao•chases 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 /> D Sg tlby. <br /> Office of the Risk Management Officer aUsa�owuf�o Date; 4/20/2016 <br /> ^GFB 1]688848 <br /> III <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> DocuS,g d by. <br /> Office of the Chief Financial Officer Date: 4/20/2016 <br /> LeLyal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> D.—S19-d by. <br /> Office of the County Attorney X66. r6yy Date: 4/22/2016 <br /> Cleric to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgorangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Revised 1/16 6 <br />