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DocuSign Envelope ID:791B8A8D-56E7-46E8-9C1E-E15DF599B542 <br /> ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: Excellance, INC. Party/Vendor Contact Person: Tommy Pugh Contact Phone: (256) 772-9321 <br /> Party/Vendor Address: 453 Lanier Rd. City Madison State: Al Zip: 35758 Department: Emergency Services Amount: <br /> $247,193.20 Purpose: Ambulance Remount (Amend #840-2252 to #843-2310) Budget Code(s): 61757535-8020000-30010 <br /> Vendor#59564 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ❑ <br /> Renewal ❑ Amendment ® Effective Date Approved by Board Yes® No❑ Agenda Date: FY18-19 BOCC <br /> 01/22/2019 <br /> This agreement is approved as to technical form Docusigned by: <br /> �t� y�tr5 10/9/2019 <br /> Department Director's Signature 5655BC89IA64473. Date: <br /> Information Technologies <br /> (Applicable only to hardware/software 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 sufficiency of insurr----D-oc-uSi9n-ea ar-----=ications,and requirements: <br /> 1US66 (AVln. 6 10/10/2019 <br /> Office of Risk Management Date: <br /> 7FDCF9176800498. <br /> Financial Services <br /> This instrument has been pre-audited in the manner re . Docusigned by: - mment Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer 4 Date: 10/11/2019 <br /> 7D4E51S1ACC1409. <br /> Legal Services <br /> This agreement is approved as to legal form and suff ' Docusigned by: <br /> Office of the County Attorney �•�'°' - Date: 10/11/2019 <br /> 4035CB8304CA4M <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised December 2016 <br />