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DocuSign Envelope ID:98A0406E-2030-44A2-8DAE-6F7B91 D48481 <br /> DS <br /> ORANGE COUNTY-DEPARTMENT USE ONL <br /> Department <br /> Party/Vendor Name: Tile Restoration, Inc. Party/Vendor Contact Person: Brad Albritton Contact Phone: 252-916- <br /> 2045 Party/Vendor Address: 119 East Main Street City Hookerton State: NC Zip: 28538 Department: AMS <br /> Amount: $9745 (requesting $1985 in combination with existing PO 1601492 balance $7760) Purpose: Flooring At <br /> Seymour Budget Code(s): 10240520-630000 Vendor# 61702 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No❑ Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 05/16/2017 <br /> Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical fop•• ,e se blt:: <br /> Department Director's Signature 24/ rt, Date: 5/11/2017 <br /> 9 E 880 A46 C F 64498... <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 /> DocuSigned""by: <br /> ''111i <br /> Office of the Risk Management Officer Q�SA �,Orv�16 Date: 5/11/2017 <br /> �---7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the ma i d ily the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer <br /> (21 Date: 5/15/2017 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form apil..seagWAciv <br /> Office of the County Attorney ,�b �� Date: 5/16/2017 <br /> `----EAA3D33ED8A8465... <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 /> Office of the Clerk to the Board Date: <br /> Revised 2/17 5 <br />