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DocuSign Envelope ID:3B617C6F-5AC0-46E6-B1CC-3E58D8A37545 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Medisolutions,Inc. Party/Vendor Contact Person: Robin Creason Contact Phone; 336-329-9060 Party/Vendor <br /> Address: 100 N. Church St., Suite B City: Burlington State: NC Zip: 27217 Department: Social Services Amount: <br /> $415,647/$75,000 Purpose: In-home aides services Budget Code(s): 10400220-630000/10400220-680026/10432020- <br /> 630100110432020-630105 Vendor# 65175 (NIA if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: <br /> (Check one)New ❑ Renewal ❑ Amendment ® Effective Date May 20. 2019 Approved by Board Yes❑No❑ Agenda <br /> Date: <br /> This agreement is approved as to technical fonn and content and I as Department Director affirmatively state work on this project has <br /> not been initiated prior to execution - Docusigned by: <br /> �N �bS0_ 7/19/2019 <br /> Department Director's Signature oocusigned ay: Date: <br /> ��iu- - t�kr 7/19/2019 <br /> Department Director's Signature Date: <br /> @7E962D1BF454=A.. <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have <br /> already begun or been completed please briefly describe the nature of the emergency condition that was addressed: <br /> Information Technologies <br /> (Applicable only to hardwarelsoftware purchases or related services)This agreement has been reviewed and is approved as to <br /> information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficient ! cuSigned by: ' rds,specifications,and requirements: <br /> Q�Sa �,DVIA.tr�b 7/1/2019 <br /> Office of the Risk Management t7ffice 7FDCF0176800408. Date; <br /> Financial Services <br /> This instrument has been pre-audited 'E7NE5181ACC1409 <br /> oocusigned by: the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officeq � Date:7/19/2019 <br /> . <br /> Le al Services <br /> This agreement is approved as t OocuSigned by: ncy:J'"ki_ 7/19/2019 <br /> Office of the County Attorney 4p35CB8304CA4M 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 12118 <br />