HomeMy WebLinkAboutR 2016-422-E AMS - Tibbens Construction - SHSC interview rm. #5 renovation DocuSign Envelope ID:9F65F1B2-3BE4-4133-A023-C80F60F07140
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: 2600.00 Purpose: SHSC Interview Room #5 Renovation Budget Code(s):
61370035-892000-30012 Vendor# 63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No®
Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 8/8/16 Approved by Board
Yes❑No® Agenda Date:
This agreement is approved as to technical form and content:
S C
Department Director's Signature bin Date: 8/5/2016
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Information Technologies
(Applicable only to harchvare/softivare 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:
D Sy tlby:
L(Dll" gawby: fa 8/5/2016
Office of the Risk Management Office s, (,6 V_ Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
D.-Sig-d by:
Office of the Chief Financial Office Date: 8/5/2016
Legal Services
This agreement is approved as to legal form and sufficiency:
D S g d by:
Office of the Count Attorne °�`� �0� Date: 8/5/2016
O
y y�e,�sDSSr_DSrta
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Revised 6/16 5
DocuSign Envelope ID:9F65F1B2-3BE4-4133-A023-C80F60F07140
Office of the Clerk to the Board Date:
I
Revised 6/16