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DocuSign Envelope ID:CC89B49F-E2D0-47EA-B03D-9AE14E7378C8 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: ROBERT DUPUIS Party/Vendor Contact Person: ROBERT DUPUIS Contact Phone: 919-966- <br /> 4131 Party/Vendor Address: 205 KENILWORTH PLACE City CHAPEL HILL State: NC Zip: 27516 Department: <br /> HEALTH Amount: $12,645 Purpose: PHARMACY SERVICES Budget Code(s): 10414020-630000/pro rg ams <br /> Vendor#47361 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) <br /> New❑ Renewal ® Amendment ❑ Effective Date 7/1/2019 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> S�_Wof 7/3/2019 <br /> Department Director's Signature aC1sF2oosEsaa5F. Date: <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that was <br /> addressed: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficienc, -i]ocusigned by: ds,specifications,and requirements: <br /> Q�t$a �"'Wt't'�6 7/3/2019 <br /> Office of the Risk Management Officer_ 7FDCF9170800498. Date: <br /> Financial Services <br /> This instrument has been pre-audited ii Docusigned by: the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: 7/3/2019 <br /> 714E5181 AM 400 <br /> Legal Services <br /> This agreement is approved as t D"uSigned by: <br /> §WAk f-A.Y1t, l v$Cb 7/3/2019 <br /> Office of the County Attorney Date: <br /> 079A4n525C0F4Fg. <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 6/19 5 <br />