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DocuSign Envelope ID:9341895D-616B-4A49-BE66-F415107E2F3B <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Circulation Party/Vendor Contact Person: Margie Driscoll Contact Phone: 215-317-2965 <br /> Party/Vendor Address: 53 State Street City Boston State: MA Zip: 02109 Department: Health Amount: 5500 <br /> Purpose: Transportation services Budget Code(s): 10414020-630000 (all projects) Vendor# 65642 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ❑ <br /> Amendment ® Effective Date 7-1-22 Approved by Board Yes❑No❑ Agenda Date: ---For Section XIV. <br /> 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 prior to execution of the agreement: <br /> Slgned by: 12/30/2 02 2 <br /> Department Director's Signature i6ZIMA S&Wof 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: These services are an essential patient service to reduce a barrier to care.We have been waiting on <br /> the vendor to agree to the amendment and to supply the signer information in order to route the amendment. <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 sufficiency of insurance standards, specifications,and requirements: <br /> Z <br /> (,awu,fl-o Slgned by: <br /> Office of the Risk Management Officer Date: 12/30/2022 <br /> DCF91}ESDOG98... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSlgned by: <br /> Office of the Chief Financial Officer� Date: 1/4/2023 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Y Attorne AuryA&Piu^w Date: 1/4/2023 <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 />