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DocuSign Envelope ID:2A15E002-72B2-412E-B773-2B3C7D7522A2 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Tibbens Construction Party/Vendor Contact Person: Mark Tibbens (tibbensconst@aol.com) <br /> Contact Phone: 919-643-2856 Party/Vendor Address: 849 Moose Tracks Trl City Cedar Grove State: NC Zip: <br /> 27231 Department: AMS Amount: NTE $13,447.17 Purpose: Structural Steel Repairs Budget Code(s): <br /> 10240320-570000 Vendor#63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract <br /> Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date August 29, 2016 Approved by Board <br /> Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> D Sg tlby. <br /> Department Director's Signature fi Date: 9/6/2016 <br /> Information Technologies <br /> (Applicable only to hrnrdware/softtivare 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 insurance standards,specifications, and requirements: <br /> D Sg tlw by. <br /> Office of the Risk Management Officer Q(,sa(h 6 Date: 9/8/2016 <br /> 3FB6GB13B80B4B?!... <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 /> D Sg tlby <br /> Office of the Chief Financial Officer Date: 9/8/2016 <br /> �r ESaaan..s,.as... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> D Sg tlby. <br /> Office of the Count y �Attorney �6L, r6 ty s Date: 9/8/2016 <br /> F{X(3D33Eb @F8+t6__ <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecount nc.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Revised 6/16 6 <br />