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ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Excellance, Inc.Party/Vendor Contact Person: Lisa BarfieldContact Phone: (256) 772-9321 <br />Party/Vendor Address: 453 Lanier RdCity MadisonState: ALZip: 35758Department: Emergency Services <br />Amount: $117,374.75Purpose: Ambulanc Remount #899Budget Code(s): 72757530 –802000 Vendor # 59564 <br />(N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New <br />Renewal Amendment Effective Date Approved by Board Yes No Agenda Date: CIP <br />Budget FY18 <br />This agreement is approved as to technical form and content: <br />Department Director’s Signature ________________________________________ 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 sufficiency of insurance standards, specifications, and requirements: <br />Office of the Risk Management Officer___________________________________ 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 />Office of the County Attorney __________________________________________Date: ________ <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersollupon completion @ Singersoll@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 />DocuSign Envelope ID: D329DEE1-1083-4935-A32C-FC00DAA234AC <br /> <br /> <br /> <br />