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DocuSign Envelope ID:9937DF18-1C51-4D9B-95B2-08C609E00193 <br /> GRANGE COUNTY-DEPARTMENT USE ONLY <br /> PartyNendor Name: Mikaela Archambeault. DVM Party/Vendor Contact Person: Mikaela Archambe_ault, DVM <br /> Contact Phone: 9I9-434-9725 Party/Vendor Address: 836 Ember Drive City Durham State: NC Zip: 27703 <br /> Department: Animal Services Amount: 5,000(total amount for all 3 vets not to exceed 50,150 for combined budget <br /> codes for the fiscal yeaJr Purpose: VeterinaKy Services Budget Code(s): 10215020 629010 and 629004 Vendor# <br /> (NIA if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ <br /> Renewal® Amendment ❑ Effective Date 07/01/19 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 /> LE <br /> cuSigned by: <br /> 1 ftaffb 7/16/2019 <br /> Department Director's Signature Date: <br /> B581]5B7DD482... <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 hardwarelsofiware 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 sufficiency of insurance standards,specifications,and requirements: <br /> D Sig d by: <br /> Office of the Risk Management Officer��sa ('owu{fo Date:7/17/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> D S g d by: <br /> -Office of the Chief Financial Officer Date: 7/17/2019 <br /> �'7D3E <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> 7/17/2019 <br /> of the County AttorneyCOfficekt,Awit, �Sco Date: <br /> 079A4D525COF4FB. <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountyne.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 /> Rev. 6119 <br />