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DocuSign Envelope ID:88577424-D976-4534-82EF-EEA3A41BAB2A <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Carolinas IT Party/Vendor Contact Person: Krsita Cathey Contact Phone: 919-573-4091 <br /> Party/Vendor Address: 1600 Hillsborough Street City Raleigh State: NC Zip: 27605 Department: Health Amount: <br /> $5,000 Purpose: Conduct HIPAA security risk analysis Budget Code(s): 10410020-630000 Vendor#64875 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 11-20-17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to to L trtd �d""content: <br /> Von ittc iMt 11/20/2017 <br /> Department Director's Signature Date: <br /> 5145A26D945C401- <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 co -• oaf§p( lcations: <br /> J1tkt iVbr'""' "1 11/20/2017 <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficient 71§§anewstandards,_ specifications,and requirements: <br /> M rbMu tl6 11/20/2017 <br /> Office of the Risk Management Office Date:F99-7G8 @0498... <br /> Financial Services <br /> This instrument has been pre-audited i LIWIFilteitquired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer An Date: 12/6/2017 <br /> B4E5181 ACC1909... <br /> Legal Services <br /> This agreement is approved as t $clbigff h Yd sufficiency: <br /> tAAAA. Altztl tt✓ SG6 12/7/2017 <br /> Office of the County Attorney o70 4D525coF4Fe... 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 5 <br />