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DocuSign Envelope ID:OE76022E-EB24-4BC8-9CBE-2BA3FA1CCA27 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Patagonia Party/Vendor Contact Person: Karen Khoury Contact Phone: 919-200-6011 <br /> Party/Vendor Address: 15100 Weston Parkway#204 City Cary State:NC Zip:27513 Department:Health Amount: <br /> 2 700 Purpose: Pay for additional Patagonia licenses for pharmacy app Budget Code(s): 61370035-800100-30012 <br /> Vendor#61583 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one) <br /> New❑ Renewal❑ Amendment ® Effective Date 3-1-22 Approved by Board Yes❑No❑ Agenda Date: <br /> ---For Section XIV. c.contracts only,Approved by Board in Current FY Budget Yes[—]No❑ <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initiated pr'or lftf"Mh of the agreement: <br /> dln�Olbi.A. 9t, o 3/10/2022 <br /> Department Director's Signature ,,,rF9DQAF3445F 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 co hftndopetifications: <br /> JtKi 4 3/10/2022 <br /> Office of the Chief Information Officer 1QA91F73Ar4nF Date: <br /> Risk Management <br /> This agreement is approved for sufficienc m rguaeoystandards, specifications,and requirements: <br /> auso, CbV1nR& 3/10/2022 <br /> Office of the Risk Management Officer s Date: <br /> Financial Services <br /> This instrument has been pre-audited i Qmmiwtequired by the Local Government Budget and Fiscal Control Act: <br /> s�oscR.�Q.e.L Office of the Chief Financial Officer Date:3/11/2022 <br /> Legal Services <br /> This agreement is approved as tc RtTMWda sufficiency: <br /> al klL Auk, Tmo 3/11/2022 <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 06/21 <br />