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DocuSign Envelope ID:69F93BE5-OFF1-412C-9392-F34F64FCO20C <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Tile Restoration Inc Party/Vendor Contact Person: Brad Albritton Contact Phone: 252-916-2045 <br /> Party/Vendor Address: 119 East Main Street City Hookerton State: NC Zip: 28538 Department: AMS Amount: <br /> 51250 Purpose: WHSC floor care Budget Code(s): 10240520-630000 Vendor # 61702 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date 01/03/2017 Approved by Board Yes❑Nor-1 Agenda Date: <br /> This agreement is approved as to technical to ,agwplggpt: <br /> Department Director's Signature �W Date: 12/20/2016 <br /> 9E880A46CF64498... <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 /> Docu5igned""by: <br /> ''11i1 <br /> Office of the Risk Management Officer Pausa, (,6rvu,�16 Date:12/20/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the ggWred by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: 12/29/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal to qffi ncy: <br /> Office of the County Attorney ,66, r6ufs Date: 12/30/2016 <br /> EAA3D33ED8A8465... <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.nic.Rov <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: <br /> Revised 6/16 5 <br />