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DocuSign Envelope ID:82EB9B39-9D7D-41C3-B72D-42EA9D2C18CD <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Tibbens Contruction Party/Vendor Contact Person: Mark Tibbens (tibbensconst&aol com) <br /> Contact Phone: 919.667.5366 Party/Vendor Address: 849 Moose Tracks Trl City Cedar Grove State: NC Zip: <br /> 27231 Department: AMS Amount: 1325.00 Purpose: Repair Dickson House front porch steps 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 12/19/16 Approved by Board Yes❑ <br /> No® Agenda Date: <br /> This agreement is approved as to technical forth and content: <br /> Do <br /> Department Director's Signature Date: 12/13/2016 <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 /> oo..s�g.ea ey: <br /> QUSO,(,awu 6 12/14/2016 <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 /> 5g,�,,,,,� <br /> Office of the Chief Financial Officer�!d? Date: 12/14/2016 <br /> Legal Services <br /> This agreement is approved as to legal forth and sufficiency: <br /> o sg aey <br /> Office of the County Attorney �6 " r6 S Date: 12/15/2016 <br /> CE�e��4� <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.plc.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Revised 6/16 6 <br />