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DocuSign Envelope ID:35E8DCE7-1CAA-4177-A55F-37F14DE3307B <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Melynee Falk Party/Vendor Contact Person: Melynee Falk Contact Phone: 336-402-1025 <br /> Party/Vendor Address: 1406 Valleymede Rd. City Greensboro State: NC Zip: 27410 Department: Health <br /> Amount: $77,597 Purpose: Regional audiology consulting services Budget Code(s): 10414020-630000-71423 <br /> Vendor#64366 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one) <br /> New❑ Renewal® Amendment ❑ Effective Date 6-1-19 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> is S�.wo- 6/11/2019 <br /> Department Director's Signatur 3C16F2D09E3445F. Date: <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: Forgot the agreement was on the State addendum fiscal year(June-May).Required contract for <br /> State addendum.Reimbursed by State for services. <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficient Wcusigned_by: <br /> . rds,specifications,and requirements: <br /> USA, CbV1n.t,{�6 6/18/2019 <br /> Office of the Risk Management Office 7F❑CF917e800498. Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> CC 6/19/2019 <br /> Office of the Chief Financial Officer 704E5181ACC1409. Date: <br /> - <br /> Legal Services <br /> This agreement is approved as t DocuSigned by: <br /> QlrtAAk N-AKif, l v$Cb 6/19/2019 <br /> Office of the County Attorney 079MD525COF4FB. 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 <br /> 8 <br />