HomeMy WebLinkAboutR 2016-177-E Tax - Zoll Data Systems, Inc. - Addendum for patient invoice - single trip ECM DocuSign Envelope ID:91182FB2-D8B4-43AB-B971-D5A34C4B619D
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Zoll Data Systems, Inc Party/Vendor Contact Person: Sandy King, Accounting Operations
Manager Contact Phone: 303-801-1876 Party/Vendor Address: 11802 Ridge Parkway, Suite 400 City Broomfield
State: Colorado Zip: 80021 Department: Tax Administration Amount: $1,950.00 Purpose: Patient Invoice —
Single Trip ECM Budget Code(s): 10335020-630000 Vendor#57181 (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑ No[] Contract Type: (Check one) New ❑ Renewal ❑ Amendment ® Effective Date
March 1,2016 Approved by Board Yes❑Nor-1 Agenda Date:
This agreement is approved as to technical form and content:
DocuSigned by:
Department Director's SignaturW� f?K1, uS6Vu Date: 3/1/2016
CPi)5EDD78428EB34BF
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
h DocuSigned by:
Office of the Chief Information Officer 5W Nby� Date: 3/3/2016
C11BA91E73A64DF_._
Risk Management
This agreement is approved for sufficiency of insurance standards,specifications,and requirements:
DocuSigned by:
Office of the Risk Management Office AUS& C,bVLt,t. 6 Date: 3/4/2016
`—7FDCF9176800498._.
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
DocuSigned by:
Office of the Chief Financial Officer��"� Date: 3/4/2016
7D4E5181ACC1409.._
Legal Services
This agreement is approved as to legal form and sufficiency:
PFAAM33EDW465 pocuSigned by:
Office o f the County Attorneyb6 r6kY5 Date: 3/7/2016
.._
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion Co) DolloydL&orangccountync.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: