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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> 6 <br /> Department <br /> Party/Vendor Name: Durham County Department of Public Health Party/Vendor Contact Person: Katie Mallette <br /> Contact Phone: 919-560-7692 Party/Vendor Address: 414 East Main Street City Durham State: NC Zip: 27278 <br /> Department: Health Amount: $15,000 Purpose: Analyze specimens and report findings Budget Code(s): <br /> 10414020-630000-71406 Vendor# 35482 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® <br /> Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7/1/17 Approved by Board�I� (1 <br /> Yes[:]No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: �� <br /> Information Technologies <br /> (Applicable onb;to hardware/softivare 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 sufficiency of insurance standards, specifications, and requirements: <br /> Office of the Risk Management Officer L� ko 0 Date: -713sV17 <br /> Financial Services <br /> This instrument has been pre-audited in the ann r uir by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: 7 Z 7 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney t �! "�` � /(,'' Date: a�l� <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dojoyd cr oran ecountvnc.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 />