HomeMy WebLinkAboutR 2017-055-E AMS - Tibbens Construction to renovate restrooms for single occupancy DocuSign Envelope ID:2E5F960A-00C2-416D-B3AC-552CB78379FF
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Tibbens Construction PartyNendor Contact Person: Mark Tibbens (tibbensconstt7a,aol.com) Contact
Phone: 919.667.5366 PartyNendor Address: 849 Moose Tracks Trl City Cedar Grove State: NC Zip: 27231 Department:
AMS Amount: $78,900.00 Purpose: Renovate Restrooms for Single Occupancy 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 January 30,2017 Approved by Board Yes❑No/1 Agenda Date:
This agreement is approved as to technical form and content:
DocuSignetl by.
Department Director's Signature Date: 1/24/2017
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:
r—DocuSignetl by:
Office of the Risk Management Office Q(,�,r„�ry sa�owuffo Date: 1/26/2017
g �—
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
r—DocuSignetl by.
Office of the Chief Financial Officer (1'N °" °" Date: 2/6/2017
Legal Services
This agreement is approved as to legal form and sufficiency:
�—DOOsigetl by:
Office of the County Attorney Attorne �0 �0� Date: 2/6/2017
�—ennaoaseoanaass_
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion -D—o llovd ci oran 'count y ync.go v
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 10