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DocuSign Envelope ID:8A89705C-498E-4AB2-AA97-D86209095601 <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 Trl City Cedar Grove State: NC Zip: <br /> 27231 Department:AMS Amount: $35,592.00 Purpose: Repair sagging sewer line required by the Town of Chapel <br /> Hill, this sewer line is a main line that supports 50% of the facility. The project is being funding using operation <br /> funds. $10,000 was awarded on PO 1702475 using 2016-17 funds,the remaining$25,592 will be from the 2017-18 <br /> funds per the codes. Budget Code(s): 10240320-570000 Vendor # 63556 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective <br /> Date July 10,2017 Approved by Board Yes' No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> i—oo<sqea oy: <br /> Department Director's Signature 74-7°- Date: 7/11/2017 <br /> Asset Management <br /> (Applicable only to construction contracts)This agreement has been reviewed and is approved as to construction <br /> services content and specifications: <br /> o sg e y <br /> fly paw 7/11/2017 <br /> Office of the Asset Management Directo Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards, specifications,and requirements: <br /> o sg aey <br /> Office of the Risk Management Office aGsa(01W-to Date: 7/12/2017 <br /> CF9170800<98_ <br /> Financial Services <br /> rl "" This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> �—oo<s�gea ey: <br /> Office of the Chief Financial Officer,1"P,Z°"� <br /> " Date: 7/17/2017 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> �—oo<s�gea ey: <br /> Office of the County Attorne )0�`'"'�otiwts Date: 7/17/2017 <br /> tY Y��,��3a��,,.� <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 /> Revised 2/17 6 <br />