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DocuSign Envelope ID:85F8B674-BOBO-49DD-905E-B4A3D145C169 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Triangle Orthopaedic Associates Party/Vendor Contact Person: Chris Adkins Contact <br /> Plione: Party/Vendor Address: 120 William Petui Plaza City Durham State: NC Zip: 27704 <br /> Department: DEAPR Amount: $40,000.00 Purpose: Partnership Budget Code(s): 20026 Vendor# (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ NoX Contract Type: (Check one) New ❑ Renewal X <br /> Amendment ❑ Effective Date 81112014 Approved by Board Yes❑NoX Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSignedd by: <br /> Department Director's Signature V� tOM,0L Date: <br /> 611CFA1D507A495... <br /> Information Teehmologies <br /> (Applicable only to har•dtiva)-elsoftivare put-chases or•related selvrces)This agreement has been reviewed and is <br /> approved as to hnformation technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> ---DocuSigned by: <br /> Office of the Risk Management Officer ausax, r,6m,&b Date: <br /> 7FDCF9176800498... <br /> Financial Services <br /> This hIst'Umellt has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> ---DocuSigned by: <br /> Office of the Chief Financial Officer �Q � �V`R ti Date: <br /> 2F982EC44C2C444... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DbocuSigned by: <br /> Office of the County Attorney otxfs Date: <br /> EAAMKEMA8465... <br /> Cleric to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dot loyd@oratigecottiitytic.gov <br /> The following signature block is for hard copies only and is not requh-ed for Docusign contracts: <br /> Office of the Cleric to the Board Date: <br />