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DocuSign Envelope ID: C269DO8B-F3B7-4EA6-BDAO-2DE5B421 F45A <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: F1oorChem 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: AMS <br /> Amount: $4902 Purpose: Flooring upgrades at Motor Pool Budget Code(s): 10240520-630000 Vendor#57002 (N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 06/09/2016 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical to Wgyt: <br /> Department Director's Signature Ye# Ao or, Date: 6/8/2016 <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 in bWMWA dards, specifications,and requirements: <br /> Office of the Risk Management Officer Qusa, (hntt N Date: 6/8/2016 <br /> 7FDCF91 6800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner%%jired by the Local Government Budget and Fiscal Control Act: <br /> u ig ed by: <br /> 6/11/2016 <br /> Office of the Chief Financial Officer F�0!c <br /> Date: <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form &AW..: <br /> Office of the County Attorney �b- r6ufs Date: 6/13/2016 <br /> EAA3D33ED8A8465... <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 />