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ORANGE COUNTY-DEPARTMENT USE ONLY C 1 ? <br /> Party/Vendor Name : Walgreens Party/Vendor Contact Person . Christopher Sutter Contact Phone : 847 - 612 -0296 <br /> Party/Vendor Address : 104 Wilmot Road, MS4446 City Deerfield State : IL Zip : 60015 Department : Health <br /> Amount : $ 10 , 000 Purpose : Manage and dispense OCHD ' s 340B drugs . Budget Code (s) : 10414020 - 630000 - <br /> 71406/71416/71418 Vendor # _ IA' (N/A if new vendor) Vendor is a BOCC consultant? Yes El No ® <br /> Contract Type : (Check one) Ne ® Renewal ❑ Amendment ❑ Effective Date 1 - 1 -2020 Approved by Board <br /> Yes ❑ No ❑ Agenda Date : <br /> lY <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 /> Department Director ' s Signature 4Date : <br /> Agreements for emergency services or pair 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 sufficiency of insurance standards , specifications , and requirements : <br /> Office of the Risk Management Officer Date : V / <br /> Financial Services <br /> This instrument has been pre - audited i4thennellrequjired y the Local Government Budget and Fiscal Control <br /> Act : <br /> Office of the Chief Financial Officer Date : j <br /> Legal Services <br /> This agreement is approved as to legal f an su cie <br /> Office of the County Attorney Date : <br /> Clerk to the Board <br /> Received for record retention : <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion : smgersoll@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 />