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DocuSign Envelope ID: 19BCEAA9-F982-42A7-972B-A7E79E20FF66 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> PartyNendor Name: MediSolutions Inc. Party/Vendor Contact Person: Robin Creason Contact Phone: 336-329- <br /> 9060 Party/Vendor Address: 100 N. Church St. Suite B. City Burlington State: NC Zip: 27217 Department: <br /> Social Services Amount: $10,000 Purpose: RN Services Budget Code(s): 10406220-622000 Vendor # 65175 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ <br /> Renewal ® Amendment ❑ Effective Date July 1, 2019 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical forth 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 /> N �b5l+btn 7/8/2019 <br /> Department Director's Signature DAE1E198A83B455 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: <br /> Information Technolozies <br /> (Applicable only to hardwarelsoftware 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 hate: <br /> Risk Management <br /> This agreement is approved for suffiicienc DocuSigned by: ids,specifications,and requirements: <br /> Office of the Risk Management Officellusa L.Q�6 7FDC F91 7e800498. �'' 7/3/2019 <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 /> lr7NE5181ACC1409. <br /> 4 � � 7/8/2019 <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as to DocuSigned by: -- icy: <br /> Office of the County Attorney -" �` '°y' - Date:7/9/2019 <br /> 4035CB8304CA4M <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: snngersoll@orangecountync.gov <br /> The following signature block is for bard 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 />