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DocuSign Envelope ID:49BCBA8C-OE7D-4617-A6F3-B8BE01DA708F <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: ROBERT DUPUIS Party/Vendor Contact Person: ROBERT DUPUIS Contact Phone: 919-966- <br /> 4131 Party/Vendor Address: 205 KENILWORTH PLACE City CHAPEL HILL State: NC Zip: 27516 Department: <br /> HEALTH Amount: $12.645 Purpose: PHARMACY SERVICES Budget Code(s): 10414020-630000 Vendor#47361 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one)New ❑ Renewal <br /> ® Amendment ❑ Effective Date 7/1/2016 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to to c°8F'�i'Wftid content: <br /> Department Director's Signature l4. � Date: 6/23/2016 <br /> Information Technolosies <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 /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficient I iistandards, specifications,and requirements: <br /> a Sa, r,Orv�c X16 6/24/2016 <br /> Office of the Risk Management Officer 7F DcFS1�s800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited i t e fte?&iluired by the Local Government Budget and Fiscal Control Act: <br /> Oq Office of the Chief Financial Officer Date: 6/27/2016 <br /> Li4E5181ACC1409. <br /> Legal Services <br /> This agreement is approved as to ga4Offififf d sufficiency: <br /> 4 '�� 6/27/2016 <br /> Office of the County Attorney im rpn'�n4ra44xi Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.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 /> Revised 6/16 4 <br />