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DocuSign Envelope ID:565001 EC-448E-411 F-84E4-E84E407F6249 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Dixon Huges Goodman,LLP Party/Vendor Contact Person: Kristi Chestnutt Contact Phone: <br /> 919-526-1824 Party/Vendor Address: 2501 B1ueRid,ge Road, Suite 500 City Raleigh State: NC Zip: 27607 <br /> Department: Health Amount: $5,500 Purpose: Prepare analysis of 2021 Cost Report Budget Code(s): 10410020- <br /> 630000 Vendor# 63893 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: <br /> (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7-1-21 Approved by Board Yes❑ No❑ <br /> Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> [�� <br /> S{l Woyf 6/28/2021 <br /> Department Director's Signature Date: <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficienc �mwmo"" ""iaystl1al1ndards,specifications,and requirements: <br /> auso. rbvv�,c.rfb 6/28/2021 <br /> Office of the Risk Management Officer Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officerrq- Date: 6/29/2021 <br /> Legal Services <br /> This agreement is approved as t eg$?T6'1q f1Nd sufficiency: <br /> Office of the Count Attorne QI � � �S(� Date: 6/29/2021 <br /> y y p1.g,nnns�srncnra <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Allen Coleman upon completion: acoleman@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 6/20 <br /> 9 <br />