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DocuSign Envelope ID:8F46C2BA-AC7A-464D-B01A-1E2581B55465 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Melynee Falk Party/Vendor Contact Person: Meylnee Falk Contact Phone: 336-402-1025 <br /> Party/Vendor Address: 803 Seven Oaks Drive City Greensoboro State: NC Zip: 27410 Department: Health <br /> Amount: $15,000 Purpose: Regional audiology consulting services Budget Code(s): 10414020-630000 Vendor# <br /> 64366 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ <br /> Renewal❑ Amendment ❑ Effective Date 4/1/17 Approved by Board Yes No Agenda Date: <br /> LXOttU1 D b This agreement is approved as to to cf m nd d co tent: <br /> l 3/30/2017 <br /> Department Director's Signature 5145A2CD945C40F... Date: <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 /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficient 4amliVit48_eys'tandards,specifications, and requirements: <br /> aMiS& rbvvutl6 3/31/2017 <br /> Office of the Risk Management Officer 7FDCF9176800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> DocuSigned by: <br /> Act: <br /> ` "' .A.x. 5/5/2017 <br /> Office of the Chief Financial Officer C(71.4., <br /> 7D4E5181ACC1409... Date: <br /> Legal Services <br /> D c igned by: <br /> This agreement is approved as t 1 a� or lan�dd suf ciency: <br /> '1' '1' ISO 5/5/2017 <br /> Office of the County Attorney 079A4D525C0F4FB... Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.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 2/17 <br /> 8 <br />