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DocuSign Envelope ID:A61 DDHMC24-421313-131324-E011 DBDAAA9B <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: F1oorChem, Inc. Party/Vendor Contact Person: Anita M. Brack Contact Phone: 919-427- <br /> 1547 Party/Vendor Address: 200 Powell Drive, Ste 103 City Raleigh State: NC Zip: 27606 Department: AMS <br /> Amount: $29,086 Purpose: flooring upgrades WHSC Bldg B Budget Code(s): 10240520-630000 Vendor# 57002 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New <br /> Renewal ❑ Amendment ❑ Effective Date 04/21/2016 Approved by Board Yes❑ No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Fi;uSig ned by:Department Director's Signature �O"`7�Of' Date: 4/19/2016 <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 insurqpce st a�gyards, specifications, and requirements: <br /> Office of the Risk Management Officer F,usa, rb�6 Date: 4/21/2016 <br /> 7FDCF917 1800498... <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 /> DocuSigned by: <br /> Office of the Chief Financial Officer Date: 4/25/2016 <br /> ('� �osr�2osz <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: . <br /> uSigne by.,'�L, <br /> Office of the County Attorney <br /> 56Z, r6ufs Date: 4/26/2016 <br /> EAA3D33EDM8465... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloydL�oranaecountync.Qov <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 <br /> 8 <br />