HomeMy WebLinkAboutR 2016-293-E AMS - Tibbens Construction for repair of concrete DocuSign Envelope ID:A495E010-63C7-4B37-9396-1C63BF41BA62
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Tibbens Construction Party/Vendor Contact Person: Mark Tibbens (Tibbensconst@aol.com)
Contact Phone: 919.667.5366 Party/Vendor Address: 849 Moose Tracks Trl City Cedar Grove State: NC Zip: 27231
Department: AMS Amount: 400.00 Purpose: Repair Concrete Budget Code(s): 61370035-880000-10016 Vendor#
63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New
Renewal❑ Amendment ❑ Effective Date 6/10/16 Approved by Board Yes❑No® Agenda Date:
This agreement is approved as to technical form and content:
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Department Director's Signature Date:
Information Technologies
(Applicable only to harchvare/sofhvar-e ptn•chases 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:
Uocu5i9ned by:
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Office of the Risk Management Office X6" 0 Date: 6 9/2016
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
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Office of the Chief Financial Officer Date: 6/10/2016
Legal Services
This agreement is approved as to legal form and sufficiency:
Uocu5i9ned by:
Office of the County Attorney �0� �oywts Date: 6/10/2016
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync.g_ov
The following signature block is for hard copies only and is not required for Docusign contracts:
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Office of the Clerk to the Board Date:
Revised 6/16 4