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DocuSign Envelope ID: FF7: QS A-4602-AD91-CF4E1D201`117 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <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#793 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 FYI <br /> This agreement is approved as tter'--;--' f,-w, � A^^^*Ant: <br /> Department Director's Signature Date:g pp ter'--;--' by: <br /> , �tVi#,S 12/6/2017 <br /> 5655BC891AI34473... <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 sufficiencv of insurance standards, specifications,and requirements: <br /> UocuSigned by: <br /> Office of the Risk Management Office ausa�emdb Date:121712017 <br /> 7FDCF9176800498... <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 /> Docu5igned by: <br /> Office of the Chief Financial Officer AI" Date: 12/8/2017 <br /> 704E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to 1P 1 fr.rrr,nnrl c„ff;r;Pncy: <br /> OocuSigned by: <br /> ry <br /> Office of the County Attorney ����,.1;rt1A1�_ Date: 12/14/2017 <br /> 4035CB8304CA4M... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkoran eg coun. c..ov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Revised 12/17 <br />