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DocuSign Envelope ID:6EC4E1AF-9212-4BF4-ACB8-3C5C4BDEE3CD <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: 2118.35 Purpose: Install protective cages around the HVAC condensate drain <br /> lines in the gym, install additional art rail in main hallway at front entrance Budget Code(s): 61370035-880000- <br /> 10016 Vendor # 63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: <br /> (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7/17/17 Approved by Board Yes' No <br /> Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> o sg y <br /> Department Director's Signature ,„ '"'°" Date: 7/11/2017 <br /> ��e�ay.a���sa,9o_ <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 /> o sg aey <br /> Qlasa(01W-to 7/12/2017 <br /> Office of the Risk Management Office ,„c„,,68ee,,,g 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 /> Office of the Chief Financial Officer Date: 7/17/2017 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> �—oos�gea ey: <br /> Office of the County Attorney )0� �otiwts Date: 7/17/2017 <br /> tY y�LH,„v,SLUeAaabS_ <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 />