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DocuSign Envelope ID: DCBF9B19-4560-44DC-A9D0-71 F645AC8BDC <br /> q <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Amanda Chapman, DVM PartyNendor Contact Person: Amanda Chapman, DVM Contact <br /> Phone: 920-246-2592 Party/Vendor Address: 104 Mullin Court City Chapel Hill State:NC Zip: 27514 Department: <br /> Amimal Services Amount: 999.99 Purpose: Veterinary Services Budget Code(s): 10215020 629004 Vendor# <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New❑ Renewal <br /> ® Amendment ❑ Effective Date July 1.2018 Approved by Board Yes[]No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initiated prior to execution of the agreement: <br /> OocuSigned by: <br /> Department Director's Signature C 6 <br /> � o{�o Date: 3/8/2019 <br /> C9B58115B7D6482... <br /> Agreements for emergency services u, ,u,an at aim,juuject 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 was <br /> addressed: rabies clinics held earlier in fiscal year <br /> f <br /> Information Technoloeies g <br /> Y <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 sufficien [QuSlgned by: ards,specifications,and requirements: <br /> dUSa (,bVln.f 6 <br /> Office of the Risk Management Oftic 7FDCF917e800498. Date; 3/8/2019 <br /> Financial Services <br /> This instrument has been pre-audited i oocusigned by: the Local Government Budget and Fiscal Control Act; <br /> 4 . 3/11/2019 <br /> Office of the Chief Financial Office Date: <br /> 704E51S1ACC1409. <br /> Leval Services <br /> This agreement is approved as T-1 <br /> ooeusigned by: <br /> �, kavit, S� 3/11/2019 <br /> Office of the County Attorne079A4D525COF4FB. Date. <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll[7a orangecountyne,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 /> 6 <br /> Revised 12/18 4 <br />