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DocuSign Envelope ID: FCA0E1BB-47B7-480B-A920-86DA50EE65BC <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Tile Restoration Inc Party/Vendor Contact Person: Brad Albritton Contact Phone: 252-916-2045 <br /> Party/Vendor Address: 119 East Main Street City Hookerton State: NC Zip: 28538 Department: AMS Amount: <br /> $2,480.88 (less $255.88 deposit already paid) Purpose: Restrooms, Kitchen & Housekeeping Closet Tile & grout <br /> surface at 129 E King St Budget Code(s): 10240520-630000 Vendor # 61702 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ No❑ Contract Type: (Check one)New® Renewal El Amendment El Effective Date <br /> 09/01/2017 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form ar{ts,g Agy: <br /> �L <br /> Department Director's Signature Pell Date: 8/25/2017 <br /> �--9E880A46CF64498... <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 insura� s,larA Ards, specifications,and requirements: <br /> ((USA COVI/ut t 8/25/2017 <br /> Office of the Risk Management Officer Date: <br /> 7FDCF9176800498... <br /> DS <br /> Financial Services r DS <br /> This instrument has been pre-audited in the ma wcwittirrixbby the Local Government Budget and Fiscal Control Act: <br /> 6/4 8/25/2017 <br /> Office of the Chief Financial Officer Date: <br /> u4t51 t51 AC(14U`J... <br /> Legal Services <br /> This agreement is approved as to legal form and suf qig. yd:by: <br /> jaLtA, lebltxfs 8/25/2017 <br /> Office of the County Attorney Date: <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 />