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DocuSign Envelope ID: ED70ABD7-FFE4-4C25-B3D1-84A819C70CE2 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Amanda Chapman, DVM Party/Vendor Contact Person: Amanda Chapman, DVM Contact <br /> Phone: 920-246-2592 Party/Vendor Address: 104 Mullin Court City Chapel Hill State:NC Zip: 27514 Department: <br /> Amimal Services Amount: 999.99 Purpose: Veterinary Services Budget Code(s): 10215020 629004 Vendor# <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal <br /> ® Amendment ❑ Effective Date July 1,2019 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 on <br /> this project has not been initiated prior to execution of the agreement: <br /> ❑ s,� M: <br /> Department Director's Signature Date:10/21/2019 <br /> :na�ei;a�nndnn <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 was <br /> 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 sufficiency of insurance standards, specifications,and requirements: <br /> ❑ 58 dhy <br /> Q�Sa fan 6 10/22/2019 <br /> Office of the Risk Management Office Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> ❑ sated ny: <br /> � 10/22/2019 <br /> Office of the Chief Financial OfficerI o� Date: <br /> rns=s vinrndx <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ❑ se�ny <br /> Qln. k lt.arr�."6scn 10/22/2019 <br /> Office of the County Attorne Date: <br /> {1]nk1n5+=C0F4FR <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 4 <br />