Orange County NC Website
Browse       Search
DocuSign Envelope ID:322475F4-3B4B-4519-AC2A-081 F7A434703 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Priority Care Ambulance, Inc Party/Vendor Contact Person: William Masone Contact <br /> Phone: 919-627-5562 Party/Vendor Address: 5116 Bur Oak Circle Suite 100 City Raleigh State:NC Zip: 27612 <br /> Department: Emergency Services Amount: NA Purpose: Franchise Agreement Budget Code(s): N/A Vendor# <br /> N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New <br /> Renewal ❑ Amendment ❑ Effective Date January 11, 2021 Approved by Board Yes® No❑ Agenda <br /> Date:December 15,2021 <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 /> DocuSigned by:S �D��/I-- ..'__,, <br /> Department Director's Signature Date: 1/11/2021 <br /> L6 <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 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: <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 /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as t L v-mayzd sufficiency: <br /> Office of the County Attorney � " 1�� Date: 1/12/2021 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@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 07/20 <br /> 9 <br />