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DocuSign Envelope ID:90CC09F4-5057-4B 1 F-AC03-CF23967BA7A0 <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 7/1/2017 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to to j flU flf ''�d� '�coo1ntent: <br /> M tUAll 6/29/2017 <br /> Department Director's Signature Date: <br /> 3115n2co94664BF... <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 sufficienc n- . Nflfgtft_ 1 standards,specifications,and requirements: <br /> U SA. rbY1A,t 16 7/3/2017 <br /> Office of the Risk Management Office 7FDCF9176800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited i e°tiff iPiVi quired by the Local Government Budget and Fiscal Control Act: <br /> (71.4.,p ` nicid'`"L 7/3/2017 <br /> Office of the Chief Financial Officer 7D4E5181ACC1409... Date: <br /> Legal Services <br /> This agreement is approved as t e 91f `'a"' �(d-��sufficiency: <br /> iktAi tL SCb 7/3/2017 <br /> Office of the County Attorney O7QM 52 CQ FB 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 6/16 4 <br />