2025-207-E-AMS-Gilban crisis diversion-Master WC GL AutoXS-10M

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Page 53 of 53 5-2-25 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Department Party/Vendor Name: Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: City State: Zip: Department: Amount: Purpose: Budget Code(s): Vendor # (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date Approved by Board Yes No Agenda Date: This agreement is approved as to technical form and content: Department Director’s Signature ________________________________________ Date: ________ Asset Management (Applicable only to construction contracts) This agreement has been reviewed and is approved as to construction content and specifications: Office of the Asset Management Director__________________________________ Date: ________ Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: Office of the Risk Management Officer___________________________________ Date: _________ Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer ____________________________________ Date: _________ Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney __________________________________________Date: ________ Clerk to the Board Received for record retention: All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@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:________ Docusign Envelope ID: 5A9E3BC2-EAE1-4C35-82D9-B4D6A375FA78 5/14/2025 5/14/2025 5/21/2025 5/21/2025 5/22/2025