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ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Excellance, Inc. Party/Vendor Contact Person: Lisa Barfield Contact Phone: (256) 772-9321 <br />Party/Vendor Address: 453 Lanier Rd City Madison State: AL Zip: 35758 Department: Emergency Services <br />Amount: $105,789.31 after take-off chassis Trade-In credit of $3,500.00 Purpose: Ambulanc Remount #794 Budget <br />Code(s): 72757530 – 802000 Vendor # 59564 (N/A if new vendor) Vendor is a BOCC consultant? Yes No <br /> Contract Type: (Check one) New Renewal Amendment Effective Date Approved by Board <br />Yes No Agenda Date: CIP Budget FY18 <br /> <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <br />Information Technologies <br /> <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 /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersoll upon completion @ Singersoll@orangecountync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br />DocuSign Envelope ID: 890AB1BA-173D-46A1-B569-D7AE7E5CA4F3 <br />5/7/2018 <br />5/8/2018 <br />5/10/2018 <br />5/18/2018