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DocuSign Envelope ID:25F1 DDD5-A13F-45AF-B2DE-CBA993575C29 <br /> ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: Piedmont Health Services Party/Vendor Contact Person: Brian Toomey Contact Phone: 919- <br /> 545-7341 Party/Vendor Address: 127 Kingston Dr City Chapel Hill State: NC Zip: 27514 Department: OCES <br /> Amount: N/A Purpose: Community Paramedics Budget Code(s): N/A Vendor # N/A (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> l---DOCUSigned by: <br /> Department Director's Signature O'er Vino Date: 9/20/2017 <br /> �—SBSSBC891A844I3... <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 sufficiency of insurance standards,specifications, and requirements: <br /> Office of Risk Management Date: <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 /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney hum.ltt*4 ? sa Date: 9/20/2017 <br /> •-079A4o52ec9F4FE... <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised 2/17 <br />