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DocuSign Envelope ID:AEDACO6E-B48B-4372-B300-7AA8EBBFCA08 <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: 1700.00 Purpose: Floor Protection, Temp Carpet,Reconf. Desk, display cases <br /> Budget Code(s): 61370035-892000-30012 Vendor# 63556 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 1/16/17 ,Ds <br /> Approved by Board Yes❑No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> D Sg tlby. <br /> Department Director's Signature l 2417-1"-"P"— Date: 1/18/2017 <br /> Information Technologies <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 /> r—DOCUSignetl by: <br /> Office of the Risk Management Officer a(sa�°wu}Io Date: 1/19/2017 <br /> /1 DUFY„ebouaeb_ <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 /> r—DOCUSignetl by. <br /> Office of the Chief Financial Officer ' Date: 1/19/2017 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> �—DOOsigetl by: <br /> col , rol,crts 1/20/2017 <br /> Office of the County Attorney D xDa Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Revised 6/16 6 <br />