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ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Tile Restoration IncParty/Vendor Contact Person: Brad AlbrittonContact Phone: 252-747- <br />2821 Party/Vendor Address: 119 East Main Street City Hookerton State: NC Zip: 28538 Department: AMS <br />Amount: $17,170Purpose: Floor care at Southern Human Services and Efland Cheeks Community CentersBudget <br />Code(s): 10240520-630000Vendor # 61702(N/A if new vendor) Vendor is a BOCC consultant? Yes No <br />Contract Type: (Check one) New Renewal Amendment Effective Date 03/02/2018Approved by Board <br />Yes No Agenda Date: <br />This agreement is approved as to technical form and content: <br />Department Director’s Signature ________________________________________ Date: ________ <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 />Office of theRisk Management Officer___________________________________ 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: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________Date: ________ <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 10/17 <br />8 <br />DocuSign Envelope ID: 11591086-0989-4E2D-8A03-5E4CDBBE1178 <br /> <br /> <br /> <br />