2016-702-E AMS - Tibbens Construction to repair Dickson House front porch

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DocuSign Envelope ID:82EB9B39-9D7D-41 C3-B72D-42EA9D2C18CD ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Tibbens Contruction 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: 1325.00 Purpose: Repair Dickson House front porch steps Budget Code(s): 10240320-570000 Vendor# 63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 12/19/16 Approved by Board Yes❑ No Agenda Date: This agreement is approved as to technical form and content: Department Director's Signature '4,74'7-- Date: 12/13/2016 Information Technologies (Applicable only to hardware/software 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: oos�gea ey: Qlisa(01W-to 12/14/2016 Office of the Risk Management Officer Date: Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: �—oos�gea ey: Office of the Chief Financial Officer (.1'61 Date: 12/14/2016 Legal Services This agreement is approved as to legal form and sufficiency: o sg aey: Colut,rohw{s 12/15/2016 Office of the County Attorney Date: 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 6