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DocuSign Envelope ID: 5FAAAC17-D6F9-46D4-BF6E-5A937A37B47F <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: 919-667-5366 Party/Vendor Address: 849 Moose Tracks Trail City Cedar Grove State: NC Zip: <br /> 27231 Department: AMS Amount: $2.150.00 Purpose: Replace 10' crown molding at the Dickson House front <br /> porch Budget Code(s): 10240320-570000 Vendor#63556 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No[] Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 11/29/16 <br /> Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical forth and content: <br /> D Sg tlby. <br /> Department Director's Signature "� Date: 12/1/2016 <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 insurance standards, specifications, and requirements: <br /> Do S g tlby. <br /> QUSOL (hw 6 12/2/2016 <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 <br /> Act: <br /> D ­­d <br /> Office of the Chief Financial Officer 4 n� Date: 12/2/2016 <br /> Legal Services <br /> This agreement is approved as to legal forth and sufficiency: <br /> D S tlby. <br /> Office of the County Attorney Date: 12/2/2016 <br /> —ENlSD33EDII1SSA6S__ <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.nlc.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Revised 6/16 6 <br />