HomeMy WebLinkAboutR 2016-521-E AMS - Tibbens Construction for Gateway caulk stairs DocuSign Envelope ID:4609F8B8-0925-4E83-84A0-57A86E163186
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Tibbens Construction Party/Vendor Contact Person: Mark Tibbens Contact Phone: 919.667-
5366 Party/Vendor Address: 849 Moose Tracks Trail City Cedar Grove State: NC Zip: 27231 Department: AMS
Amount: 700.00 Purpose: Gateway Caulk Stairs Budget Code(s): 10240320-570000 Vendor 9 63556 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑
Amendment ❑ Effective Date 9/8/16 Approved by Board Yes❑No® Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature Date:
Information Technologies
(Applicable only to hardware/softtivare 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:
Uo 59 dby:
Office of the Risk Management Office r[__1 (awuflo Date: 9/12/2016
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
d dby
Office of the Chief Financial OfficerE Date: 9/12/2016
Legal Services
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:
This agreement is approved as to legal form and sufficiency:
U 5'9 dby
,411 tol�w{s 9/12/2016
Office of the County Attorney� a ss Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@oran eg countync.gov
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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 6/16 5