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DocuSign Envelope ID:C7EABF72-ADAA-4072-B58C-21B9B8A9AF97 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Dixon Huges Goodman,LLP Party/Vendor Contact Person: Kristi Chestnutt Contact Phone: <br /> 919-526-1824 Party/Vendor Address: 2501 B1ueRid,ge Road, Suite 500 City Raleigh State: NC Zip: 27607 <br /> Department: Health Amount: $5,500 Purpose: Prepare analysis of 2019 Cost Report Budget Code(s): 10410020- <br /> 630000 Vendor# 63893 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: <br /> (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7-1-19 Approved by Board Yes❑ No❑ <br /> 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 /> �utn AanA S&Wof 7/12/2019 <br /> Department Director's Signature sCisF2oosEsaa5F. 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 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-- -roocu5igned 6y:`---'-rds,specifications,and requirements: <br /> U$66 (,bVln.t,{�6 7/15/2019 <br /> Office of the Risk Management Officer.[, Date: <br /> 7FDCF9178800498. <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 /> 4 . 7/15/2019 <br /> Office of the Chief Financial Officer 1ACCAN. Date: <br /> Legal Services <br /> This agreement is approved as t DocuSigned by: <br /> � x �- S� 7/15/2019 <br /> Office of the County Attorney 079A4D525C0F4FB. 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 />