HomeMy WebLinkAboutR 2016-654-E AMS - Tibbens Construction to install access hatch DocuSign Envelope ID:8AD3FDAA-DCB9-475F-880E-66361 E37859C
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Tibbens Construction Party/Vendor Contact Person: Mark Tibbens (TibbensconstRcaol.com)
Contact Phone: 919.667:5366 Party/Vendor Address: 849 Moose Tracks Trail City Cedar Grove State: NC Zip:
27231 Department: AMS Amount: 995.00 Purpose: Install Access Hatch Budget Code(s): 61370035-880000-30001
Vendor# 63556 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)
New® Renewal ❑ Amendment ❑ Effective Date 11/11/16 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 hardtivare/softvvare pzzrchases 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:
Office of the Risk Management Officer Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date:
1
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney Date:
Cleric to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion a Dolloyd@orangecountync.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: I
Revised 6/16 4