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DocuSign Envelope ID:OB9D9800-1906-43A7-8OF7-F2EBC1B3033F <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Matala Psychological Services Party/Vendor Contact Person: Kristy Matala Contact Phone: <br /> 919-339-1515 Party/Vendor Address: 7633 Wilderness Rd. City Ralei State: NC Zip: 27613-1628 <br /> Department: Social Services Amount: $10,000 Purpose: psychological evaluations/court testimony Budget <br /> Code(s): 1-0400220-761005/10405020-768000 Vendor # 63745 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date <br /> 7/l/2020 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 <br /> on this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> NOUn U1 Department Director's Signature (him, Date: 2/17/2021 <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 sufficient &a& gHaa""tys""taa1ndards, specifications,and requirements: <br /> Q�tSA Cbvvticllb 1/20/2021 <br /> Office of the Risk Management Officer FDeF91-7 8 64Q 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: Do +� �cuSigned by: <br /> �� <br /> Office of the Chief Financial Officer Date: 2/18/2021 <br /> Legal Services <br /> This agreement is approved as tTfeg@AcF60mcftd sufficiency: <br /> Office of the County Attorney <br /> �' Date: 2/21/2021 <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 />