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DocuSign Envelope ID:3972E6CB-2728-4F85-9405-C3827B138ABF <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Logistics Health Inc. Party/Vendor Contact Person: Clifford Guest Contact Phone: 860-978- <br /> 1830 Party/Vendor Address: 328 Front Street South City La Crosse State: WI Zip: 54601 Department: Health <br /> Amount: $00 Purpose: Facility Use Agreement Budget Code(s): N/A Vendor # N/A (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ <br /> Effective Date 6-2-21 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 /> it ALtA Department Director's Signature sh" yf Date: 6/2/2021 <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 sufficienc q L"Atwstandards,specifications,and requirements: <br /> gusx (hvvdb 6/3/2021 <br /> Office of the Risk Management Officer 7FDCF9176800498 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 Officer el-taDate: 6/4/2021 <br /> Legal Services <br /> This agreement is approved as t 00mc td sufficiency: <br /> Qkk t, Aurit, Tmo 6/4/2021 <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 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 />