HomeMy WebLinkAboutR 2017-169-E AMS - Tile Restoration, Inc. for flooring at Seymour Center DocuSign Envelope ID:98A0406E-2030-44A2-8DAE-6F7B91 D48481
DS
ORANGE COUNTY-DEPARTMENT USE ONL
Department
Party/Vendor Name: Tile Restoration, Inc. Party/Vendor Contact Person: Brad Albritton Contact Phone: 252-916-
2045 Party/Vendor Address: 119 East Main Street City Hookerton State: NC Zip: 28538 Department: AMS
Amount: $9745 (requesting $1985 in combination with existing PO 1601492 balance $7760) Purpose: Flooring At
Seymour Budget Code(s): 10240520-630000 Vendor# 61702 (N/A if new vendor) Vendor is a BOCC consultant?
Yes ❑ No❑ Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 05/16/2017
Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to technical fop•• ,e se blt::
Department Director's Signature 24/ rt, Date: 5/11/2017
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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:
DocuSigned""by:
''111i
Office of the Risk Management Officer Q�SA �,Orv�16 Date: 5/11/2017
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Financial Services
This instrument has been pre-audited in the ma i d ily the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer
(21 Date: 5/15/2017
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Legal Services
This agreement is approved as to legal form apil..seagWAciv
Office of the County Attorney ,�b �� Date: 5/16/2017
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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:
Office of the Clerk to the Board Date:
Revised 2/17 5