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DocuSign Envelope ID:92EFA578-CE94-4EDA-BAE5-D7664F2BE88A <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Health Ascent Associates, LLC Party/Vendor Contact Person: Dr. Dorothy Cilenti Contact <br /> Phone: 919-360-0039 Party/Vendor Address: 238 Trout Liles City Pittsboro State: NC Zip: 27312 <br /> Department: Health Amount: $8,700 Purpose: Provide support/coaching to new Health Director Budget Code(s): <br /> 10410020-630000 Vendor#64876 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract <br /> Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 12-18-17 Approved by Board Yes❑ <br /> No❑ Agenda Date: <br /> This agreement is approved as to to DocuSigned by: it: <br /> �bV'b{�i Department Director's Signature Date:12/11/2017 <br /> 5145A2CD945C40F... <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 sufficienc -6ocuSigned by: rds, specifications,and requirements: <br /> US66 �,bV1n.0 6 12/12/2017 <br /> Office of the Risk Management Officer[,7FDCF9176800498... 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: DocuSigned by: <br /> Office of the Chief Financial Officer 704E5181ACC1409. Date:12/12/2017 <br /> .. <br /> Legal Services <br /> This agreement is approved as t oocusigned by: <br /> §W.Ak t` $Lb 12/12/2017 <br /> Office of the County Attorney fl79A4D525C0F4FB... Date' <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd&oran eg countync. og_v <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 10/17 <br /> 9 <br />