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DocuSign Envelope ID:8AD3FDAA-DCB9-475F-880E-66361 E37859C <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Tibbens Construction Party/Vendor Contact Person: Mark Tibbens (TibbensconstRcaol.com) <br /> Contact Phone: 919.667:5366 Party/Vendor Address: 849 Moose Tracks Trail City Cedar Grove State: NC Zip: <br /> 27231 Department: AMS Amount: 995.00 Purpose: Install Access Hatch Budget Code(s): 61370035-880000-30001 <br /> Vendor# 63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) <br /> New® Renewal ❑ Amendment ❑ Effective Date 11/11/16 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: <br /> Information Technologies <br /> (Applicable only to hardtivare/softvvare pzzrchases 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 /> Office of the Risk Management Officer Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: <br /> 1 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney Date: <br /> Cleric to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion a Dolloyd@orangecountync.gov <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: I <br /> Revised 6/16 4 <br />