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DocuSign Envelope ID:47B4445A-C7CA-4D2E-9075-2AFD82F82DEC <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: NC Health Information Exchange Authority Party/Vendor Contact Person: Legal Team <br /> Contact Phone: 919-754-6928 Party/Vendor Address: Mail Service Center 4101 City Raleigh State: NC Zip: <br /> 27699-4101 Department: Orange County Emergency Services - EMS Amount: $0.00 Purpose: State mandated <br /> electronic health information exchange network agreement Budget Code(s): NA Vendor # NA (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date June 1,2019 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 <br /> on this project has not been initiated prior to execution of the agreement: <br /> UoeuSigned by: <br /> 15655BC89IA64473 <br /> t� ��f'5 <br /> Department Director's Signature Date: 5/29/2019 <br /> . <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 or related services)This agreement has been reviewed and is <br /> approved as to information technology content any' oacu5igned by: <br /> Office of the Chief Information Officer ik 4&ny Date: 5/29/2019 <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, -- oeuSigned dy: <br /> Office of the County Attorney �'°' - Date: 5/29/2019 <br /> O <br /> E4035C@8304CA4A9 <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 <br />