R 2016-521-E AMS - Tibbens Construction for Gateway caulk stairs

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DocuSign Envelope ID:4609F8B8-0925-4E83-84A0-57A86E163186 ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Tibbens Construction Party/Vendor Contact Person: Mark Tibbens Contact Phone: 919.667- 5366 Party/Vendor Address: 849 Moose Tracks Trail City Cedar Grove State: NC Zip: 27231 Department: AMS Amount: 700.00 Purpose: Gateway Caulk Stairs Budget Code(s): 10240320-570000 Vendor 9 63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 9/8/16 Approved by Board Yes❑No® Agenda Date: This agreement is approved as to technical form and content: Department Director's Signature Date: Information Technologies (Applicable only to hardware/softtivare 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: Uo 59 dby: Office of the Risk Management Office r[__1 (awuflo Date: 9/12/2016 Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: d dby Office of the Chief Financial OfficerE Date: 9/12/2016 Legal Services a : This agreement is approved as to legal form and sufficiency: U 5'9 dby ,411 tol�w{s 9/12/2016 Office of the County Attorney� a ss Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@oran eg countync.gov i The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 6/16 5