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Revised 01/24 <br />9 <br />ORANGE COUNTY—INTERNAL USE ONLY <br />______________________________________________________________________________ <br />Finance Information <br />Vendor Name: KKJ Foresnsic and Psychological Services, PLLC. Vendor Contact Person: Katrina Kuzyszyn- <br />Jones Phone: 919-493-1975 Address: 5501 Fortune's Rdige Dr, Suite R City Durham State: NC Zip: 27713 <br />Department: Social Services Amount: 8,000 Purpose: psychological services Budget Code(s): 10400220- <br />761005/10405020-768000 Vendor # 61106 <br />Vendor Status with NCSOS: Current-Active Vendor is a BOCC consultant: Yes No <br /> <br />Contract Details <br />Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment ) <br />Effective Date 7/1/24 End Date 6/30/25 Notice Date (Notice Purpose ) <br /> <br />Award <br /> Approved by Board (Agenda Date: ); Made or Administered by Nancy Coston <br /> <br />Signature Authority <br />- BOCC Express Delegation (Agenda Date: ) <br />- Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000 <br />- Budget Policy Section XV (Capital Improvement Project: ) <br /> <br />Bidding <br /> Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# ) <br />Department Affirmation <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state <br />work on this project has not been initiated prior to execution of the agreement. <br /> This agreement is approved as to technical form and content. Services related to this agreement have already <br />begun or been completed. Description of the nature of the emergency condition that was addressed: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <br />Information Technologies <br />This agreement has been reviewed and is approved as to information technology content and specifications: <br /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> Inapplicable because no hardware/software purchases or related services <br /> <br />Risk Management <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br />Financial Services <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br />Clerk to the Board <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 />Received for record retention: <br />DocuSign Envelope ID: 2DE26E82-5437-4B81-8D1E-C24B7BCA528F <br />6/27/2024 <br />7/1/2024 <br />7/2/2024 <br />7/2/2024