HomeMy WebLinkAboutR 2017-136-E AMS - Tibbens Construction to install door between new single occupancy restroom and locker room DocuSign Envelope ID:6CBDC816-7157-47E6-991 B-C295A7AB3612
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 Trail City Cedar Grove State: NC Zip:
27231 Department: AMS Amount: $2.500.00 Purpose: Install door between new single occupancy restroom and
the locker room to keep public from entering employee only space 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 4/10/17 Approved by Board Yes❑ No❑ Agenda
Date:
This agreement is approved as to technical form and content:
Department Director's Signature �e�ao.a���sa,9o_:'"o Date: 4/4/2017
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Asset Management
(Applicable only to construction contracts)This agreement has been reviewed and is approved as to construction
services content and specifications:
Office of the Asset Management Director Date:
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications,and requirements:
�—oos�gea ey:
Office of the Risk Management Officer aGsa(01W-to Date: 4/5/2017
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 rl'ta " Date: 4/11/2017
Legal Services
This agreement is approved as to legal form and sufficiency:
oos�gea ey:
,)o(un,roknts 4/12/2017
Office of the County Attorney,_ xooAagsr Date:
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 2/17 6
DocuSign Envelope ID:6CBDC816-7157-47E6-991 B-C295A7AB3612
Office of the Clerk to the Board Date:
Revised 2/17 7