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ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Physio-Control, Inc. Party/Vendor Contact Person: Alexandra Carvalho Contact Phone: 800- <br />442-1142 x 74003 Party/Vendor Address: 11811 Willows Rd. NE City Redmon State: Washington Zip: 98052 <br />Department: Emergency Services Amount: $30,315.00 Purpose: Physio Control Life Pak 15 service and <br />maintenance Budget Code(s): 10757520571000 Vendor # 45414 (N/A if new vendor) Vendor is a BOCC <br />consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date July <br />1, 2015 Approved by Board Yes No Agenda Date: <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <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 sufficiency of insurance standards, specifications, and requirements: <br />Office of the Risk Management Officer___________________________________ 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: <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________Date: ________ <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br />DocuSign Envelope ID: C12F223A-4347-43A3-A8B5-16DEB750E333 <br /><br />  <br /><br /><br /> <br /><br /><br /> <br /><br /><br />