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DocuSign Envelope ID:CB1 82 934-0461-457E-A18F-D1E5A8C2A3B1 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Departmcit <br /> Party/Vendor Name: Tibbens Construction Party/Vendor Contact Person: Mark Tibbens Contact Phone: 914-643- <br /> 2856 Party/Vendor Address: 849 Moose Tracks Trail City Cedar Grove State: NC Zip: 27231 Department: AMS <br /> Amount: $5,050.00 Purpose:Dick_son House Ramp Budget Code(s): 10240320-570000 Vendor#163556 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) New ❑ Renewal ❑ <br /> Amendment ❑ Effective Date 10/19/2016 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to tecL_:_ j r_-.._ -+ ---4-nt: <br /> g PP �ocuSigned dy: <br /> Department Director's Signature �`r36 Aos,, Date:: Asset Management Services Di recto <br /> 9E88C-A46CF64498... <br /> Information Technologies <br /> (Applicable only to hardwarelsoftware 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 suffiicienc' "WocuSigned ay:' ' -ds,specifications,and requirements; <br /> l�tSa �,bVln.t.{�6 Office of the Risk Management Officer Date; 10/31/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited' Doeusigned ay: the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Office 1ACC 1409. Date: 10/31/2016 <br /> 7D4E5a8 .. —�—� <br /> Le,aa1 Services <br /> This agreement is approved as to Docusigned ay: ;iency: <br /> �b� r6�tk � 11/1/2016 <br /> Office of the County Attorney_ EAAM33ED&A905... Date: I <br /> Clerk to the Board f <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 /> I <br /> Revised 6116 5 <br />