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Home My WebLink AboutR 2016-116-E Tax - ZirMed Inc. - electronic submission of patient claims and ancillary EDI services for in-house ambulance billing - collections DocuSign Envelope ID:90B9D659-59OB-40CA-85C6-4FA2FEE9lF35 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: ZirMed Inc Party/Vendor Contact Person: Ann Campbell Contact Phone: Party/Vendor Address: 501 N Broadway,3rd Floor City St. Louis State: Missouri Zip: 63102 Department: Tax Administration Amount: $9,400 Purpose: Provide electronic submission of patient claims and other ancillary EDI services for In- House Ambulance Billing and Collection. Budget Code(s): 10335020-630000 Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date January 1,2016 Approved by Board Yes❑Nor-1 Agenda Date: This agreement is approved as to technical forth and cgn tTtt:Aned by: Department Director's Signature pWam, j5n,vuS6vu Date: 1/11/2016 5EDD78428EB34BF... Information Technolosies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Docu5igned by: Office of the Chief Information Officer 53lM W Date: 1/11/2016 C11BA91E73A64DF... Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: Docu5igned""by: ''11i1 Office of the Risk Management Officer Pausa, (,6rvu,�16 Date: 1/12/2016 7FDCF9176800498... Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: F�-CN ocuSigned by: Office of the Chief Financial Officer Date: 1/12/2016 7D4E5181ACC1409... Legal Services This agreement is approved as to legal form and stied by: �bUIn, Office of the County Attorney �( Date: 1/12/2016 165- Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecount.nic.gov The following signature block is for hard copies only and is not required for Docusign contracts: DocuSign Envelope ID:90B9D659-590B-40CA-85C6-4FA2FEE9lF35 Office of the Clerk to the Board Date: