R 2016-422-E AMS - Tibbens Construction - SHSC interview rm. #5 renovation

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DocuSign Envelope ID:9F65F1B2-3BE4-4133-A023-C80F60F07140 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Tibbens Construction Party/Vendor Contact Person: Mark Tibbens (Tibbensconst@aol.com) Contact Phone: 919.667.5366 Party/Vendor Address: 849 Moose Tracks Trl. City Cedar Grove State: NC Zip: 27231 Department: AMS Amount: 2600.00 Purpose: SHSC Interview Room #5 Renovation Budget Code(s): 61370035-892000-30012 Vendor# 63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 8/8/16 Approved by Board Yes❑No® Agenda Date: This agreement is approved as to technical form and content: S C Department Director's Signature bin Date: 8/5/2016 �9F80DA96�01930... Information Technologies (Applicable only to harchvare/softivare purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: D Sy tlby: L(Dll" gawby: fa 8/5/2016 Office of the Risk Management Office s, (,6 V_ Date: Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: D.-Sig-d by: Office of the Chief Financial Office Date: 8/5/2016 Legal Services This agreement is approved as to legal form and sufficiency: D S g d by: Office of the Count Attorne °�`� �0� Date: 8/5/2016 O y y�e,�sDSSr_DSrta Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Revised 6/16 5