HomeMy WebLinkAboutR 2015-545-E AMS - FloorChem, Inc. to install epoxy flooring at the Sheriff's Office DocuSign Envelope ID: FFF24A59-BA65-479A-B4C4-5483423483E9
DS
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: FloorChem,Inc Party/Vendor Contact Person: Anita M.Brack,Owner Contact Phone: 919-854-
9776 Party/Vendor Address: 200 Powell Drive, Ste 103 City Raleigh State: NC Zip: 27606 Department: Asset
Management Services Amount: 9380 Purpose: Install epoxy flooring at the Sheriffs Office Budget Code(s):
10240320-570001 Vendor# 57002 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract
Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 10101115 Approved by Board Yes❑No
❑ Agenda Date:
This agreement is approved as to technical form and content:
5y;uSigned bDepartment Director's Signature �OfN?nOf1 Date: 10/5/2015
9E880A46CF64498...
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficiency of insurance standards,specifications,and requirements:
DocuSigned""by:
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Office of the Risk Management Officer QUSa. (hVV,&b Date: 10/5/2015
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
---DocuSigned by:: ''
Office of the Chief Financial Officer rNAL l(fbin, Date: 10/7/2015
232DFFC2CFA847B...
Legal Services
This agreement is approved as to legal form and sufficiency:
Signed by:
Office of the County Attorney 56Z, otxfs Date: 10/7/2015
EAAMKEMA8465...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@oran e� countync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 10/14 4