HomeMy WebLinkAboutR 2018-183 Emergency Svc - Excellance Ambulance Remount #794ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Excellance, Inc. Party/Vendor Contact Person: Lisa Barfield Contact Phone: (256) 772-9321
Party/Vendor Address: 453 Lanier Rd City Madison State: AL Zip: 35758 Department: Emergency Services
Amount: $105,789.31 after take-off chassis Trade-In credit of $3,500.00 Purpose: Ambulanc Remount #794 Budget
Code(s): 72757530 – 802000 Vendor # 59564 (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: CIP Budget FY18
This agreement is approved as to technical form and content:
Department Director’s Signature ________________________________________ Date: ________
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:
Office of the Chief Information Officer___________________________________ 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: 890AB1BA-173D-46A1-B569-D7AE7E5CA4F3
5/7/2018
5/8/2018
5/10/2018
5/18/2018