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DocuSign Envelope ID:AE2871`51-011384E78-13810-3524813313131DE2 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Excellanec, INC Party/Vendor Contact Person: Tommy Pugh Contact Phone: 256 772- <br /> 9321 Party/Vendor Address: 453 Lanier Rd City Madison State: AL Zip: 35758 Department: Emergency <br /> Services Amount: $247,193.20 Purpose: Ambulance Remount 0840 and #813) Budget Code(s): 61757535- <br /> 802000-30010 Vendor# 59564 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br /> Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date Approved by Board Yes®No <br /> ❑ Agenda Date: CIP Budget FYI 8-19,BOCC Meeting 1/22/2019 <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> ,�t.,�V'tt,S <br /> Department Director's SignatureFvt"� Date: 2/5/2019 <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases and 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 ®wawstandards,specifications,and requirements: <br /> gusa nu,1T0 2/6/2019 <br /> Office of the Risk Management Office 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 lq.-N O.��1. Date: 2/13/2019 <br /> Legal Services <br /> This agreement is approved as t .1cffl fdaWd sufficiency: <br /> 2/14/2019 <br /> Office of the County Attorney 1,6VK_ Date: <br /> Clerk to the Board <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 /> Office of the Clerk to the Board Date: <br /> Revised 12/18 8 <br />