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Revised 10/17 <br />8 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Melynee Falk Party/Vendor Contact Person: Meylnee Falk Contact Phone: 336-402-1025 <br />Party/Vendor Address: 803 Seven Oaks Drive City Greensboro State: NC Zip: 27410 Department: Health <br />Amount: $77,597 Purpose: Regional audiology consulting services Budget Code(s): 10414020-630000-71423 <br />Vendor # 64366 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) <br />New Renewal Amendment Effective Date 6-1-18 Approved by Board Yes No Agenda Date: <br /> <br /> <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <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 /> <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 /> <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 /> <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 /> <br />Clerk to the Board <br /> <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 /> <br /> <br />DocuSign Envelope ID: BB4B5E63-95D6-479B-914C-72E3500C9FAC <br />7/17/2018 <br />7/19/2018 <br />7/19/2018 <br />7/20/2018