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ORANGYE COUNTY --- DEPARTMENT USE ONLY---HARD COPY ONLY <br />Department <br />Party/Vendor Name: QN(r' Health Carc Syg�j­q PartyNendor Contact Pei-son: Rebecca Dixon Contact Pho= <br />984-974-7058 Party/Vendor Address: City. State: Zip: Deparbilent: 1 Icqltb Amount: <br />11211, � )I, Pm-pose: Nevi EMR, qyqq heafth chnic Budget Code(s): l.0414Q2Q�QQQQQ Vendor # 308,92/R 12 <br />. g 111joy . ........ . . <br />(N/A if new vendor) Vendor is a BOCC consultant? Yes El NOM ContTact. Type:! (Check one) New 0 <br />Renewal F] Amendment M Effective Date 6-26-18 Approved by Board YesE NoEll Agenda Date. 3-20- <br />18 <br />This agreement is approved as to technical forma and epnterIV <br />r. <br />Department Director's Signature . ....... .. . ... <br />Information Technolo <br />2ei �i <br />(Al.yVicable car l.v to purcheut� or related service) 11is; agreement has been reviewed and is <br />approved as to information technology content and specifications: <br />Office, ofthe Chief Information Of <br />Rish Managemen <br />This agreement is approved for sufficieney ofinsuranec standards, specifications, and requirements: <br />Office of Risk Management ........... . ... . .... 411.1 .... . . ..... I . .... . ...... k_', Date: <br />� -------- - --------- <br />This instrument has been pre-audited <br />Act: <br />Office of the Chief Mnancial Officer <br />Legal Services <br />anent Budget and Fiscal ContM <br />DaW. <br />This, agreement is approved as to legal form and sufficiency: <br />Off-ice of the County Attorney _,L, /t, ...Date: . 5 <br />Clerk, to the Board <br />Received for rccord retention: <br />oa rd <br />Office of the 0erk to the B <br />Revised 2117 <br />