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11 <br /> ORANGE COUNTY—INTERNAL USE ONLY <br /> Finance Information <br /> Vendor Name: Excellance,Inc Vendor Contact Person: Lisa Barfield Phone: (256)772-9321 Address:453 <br /> Lanier Road City Madison State:AL Zip: 35758 Department:Emergency Services Amount: $842,249.86 <br /> Purpose: Two(2)new ambulances Budget Code(s): 61354035-80216-12000 Vendor#56564 <br /> Vendor Status with NCSOS: Registered Vendor is a BOCC consultant: ❑Yes ®No <br /> Contract Details <br /> Contract Type: ®New ❑Amendment(Original Contract: )(Most Recent Amendment ) <br /> Effective Date End Date Notice Date (Notice Purpose ) <br /> Award <br /> ❑Approved by Board(Agenda Date:); ❑ Made or Administered by <br /> Signature Authority <br /> ❑ BOCC Express Delegation(Agenda Dater <br /> Policy 9.4: ❑Under$5,000; ❑ Service Under$90,000; ❑ Construction Under$250,000 <br /> ❑ Budget Policy Section XV(Capital Improvement Project: ) <br /> Bidding <br /> ❑Informal Bidding($30k-$90k); ❑Formal RFP($90k+); ❑ Other(<$30k); ® Exception(#NCSA#25- <br /> OS-0521 <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 /> Department Director's Signature Date: <br /> Information Technologies <br /> This agreement has been reviewed and is approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> ❑Inapplicable because no hardware/software purchases or related services <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> Office of the Risk Management Officer Date: <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 /> Office of the Chief Financial Officer Date: <br /> Leual Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney Date: <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 /> Revised 01/24 <br /> 9 <br />