HomeMy WebLinkAboutR 2016-730 AMS - Tibbens Construction Dickson House ramp DocuSign Envelope ID:CB1 82 934-0461-457E-A18F-D1E5A8C2A3B1
ORANGE COUNTY—DEPARTMENT USE ONLY
Departmcit
Party/Vendor Name: Tibbens Construction Party/Vendor Contact Person: Mark Tibbens Contact Phone: 914-643-
2856 Party/Vendor Address: 849 Moose Tracks Trail City Cedar Grove State: NC Zip: 27231 Department: AMS
Amount: $5,050.00 Purpose:Dick_son House Ramp Budget Code(s): 10240320-570000 Vendor#163556 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) New ❑ Renewal ❑
Amendment ❑ Effective Date 10/19/2016 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to tecL_:_ j r_-.._ -+ ---4-nt:
g PP �ocuSigned dy:
Department Director's Signature �`r36 Aos,, Date:: Asset Management Services Di recto
9E88C-A46CF64498...
Information Technologies
(Applicable only to hardwarelsoftware 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 suffiicienc' "WocuSigned ay:' ' -ds,specifications,and requirements;
l�tSa �,bVln.t.{�6 Office of the Risk Management Officer Date; 10/31/2016
7FDCF9176800498...
Financial Services
This instrument has been pre-audited' Doeusigned ay: the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Office 1ACC 1409. Date: 10/31/2016
7D4E5a8 .. —�—�
Le,aa1 Services
This agreement is approved as to Docusigned ay: ;iency:
�b� r6�tk � 11/1/2016
Office of the County Attorney_ EAAM33ED&A905... Date: I
Clerk to the Board f
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:
I
Revised 6116 5