R 2017-055-E AMS - Tibbens Construction to renovate restrooms for single occupancy

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DocuSign Envelope ID:2E5F960A-00C2-416D-B3AC-552CB78379FF ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Tibbens Construction PartyNendor Contact Person: Mark Tibbens (tibbensconstt7a,aol.com) Contact Phone: 919.667.5366 PartyNendor Address: 849 Moose Tracks Trl City Cedar Grove State: NC Zip: 27231 Department: AMS Amount: $78,900.00 Purpose: Renovate Restrooms for Single Occupancy Budget Code(s): 61370035-880000-30001 Vendor#63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No Contract Type: (Check one)New Renewal❑ Amendment ❑ Effective Date January 30,2017 Approved by Board Yes❑No/1 Agenda Date: This agreement is approved as to technical form and content: DocuSignetl by. Department Director's Signature Date: 1/24/2017 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: r—DocuSignetl by: Office of the Risk Management Office Q(,�,r„�ry sa�owuffo Date: 1/26/2017 g �— Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: r—DocuSignetl by. Office of the Chief Financial Officer (1'N °" °" Date: 2/6/2017 Legal Services This agreement is approved as to legal form and sufficiency: �—DOOsigetl by: Office of the County Attorney Attorne �0 �0� Date: 2/6/2017 �—ennaoaseoanaass_ Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion -D—o llovd ci oran 'count y ync.go v The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 6/16 10