2021-676-E-Risk Mgr-Alliant Insurance Services-Insurance Brokerage

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DocuSign Envelope ID: 17405374-3F52-4EE3-A40B-COBD1EOB0058 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Alliant Insurance Services, Inc. Party/Vendor Contact Person: Mark Goode mark. og ode&alliant.com Contact Phone: 704-594-7311 Party/Vendor Address: 101 N. Tryon Street, 61 floor City Charlotte State:NC Zip: 28246 Department: Risk Management Amount: $45,000 Purpose: Insurance Brokerage Services Budget Code(s): 10230220-641015 Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 12/1/2021 Approved by Board Yes❑No® Agenda Date: ---For Section XIV. c. contracts only, Approved by Board in Current FY Budget Yes[—]Nor-1 This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: DocuSigned by: Department Director's Signature fir S kmVV,4_ Date: 12/2/2021 Agreements for emergency services or repair ar &LbjuQbt94be above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologies (Applicable only to hardware/software purchases and related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: DocuSigned"by: '1L Office of the Risk Management Officer PUS& rbV'In t.{fb Date: 12/2/2021 7FDCF9176800498... Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: Office of the Chief Financial Officer +� Date: 12/2/2021 7D4E5181ACC1409... Legal Services This agreement is approved as to legal form and suffic�eng: h ocu geed by:, �, Office of the County Attorney I°bl� �16 tyv Date: 12/2/2021 EAA3D33ED8A8465... Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 06/21 9