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DocuSign Envelope ID:91182FB2-D8B4-43AB-B971-D5A34C4B619D <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Zoll Data Systems, Inc Party/Vendor Contact Person: Sandy King, Accounting Operations <br /> Manager Contact Phone: 303-801-1876 Party/Vendor Address: 11802 Ridge Parkway, Suite 400 City Broomfield <br /> State: Colorado Zip: 80021 Department: Tax Administration Amount: $1,950.00 Purpose: Patient Invoice — <br /> Single Trip ECM Budget Code(s): 10335020-630000 Vendor#57181 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No[] Contract Type: (Check one) New ❑ Renewal ❑ Amendment ® Effective Date <br /> March 1,2016 Approved by Board Yes❑Nor-1 Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's SignaturW� f?K1, uS6Vu Date: 3/1/2016 <br /> CPi)5EDD78428EB34BF <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> h DocuSigned by: <br /> Office of the Chief Information Officer 5W Nby� Date: 3/3/2016 <br /> C11BA91E73A64DF_._ <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 Office AUS& C,bVLt,t. 6 Date: 3/4/2016 <br /> `—7FDCF9176800498._. <br /> Financial Services <br /> This instrument 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��"� Date: 3/4/2016 <br /> 7D4E5181ACC1409.._ <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> PFAAM33EDW465 pocuSigned by: <br /> Office o f the County Attorneyb6 r6kY5 Date: 3/7/2016 <br /> .._ <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion Co) DolloydL&orangccountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br />