HomeMy WebLinkAboutR 2019-078 Emergency Svc - Excellance Ambulance remounts DocuSign Envelope ID:AE2871`51-011384E78-13810-3524813313131DE2
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Excellanec, INC Party/Vendor Contact Person: Tommy Pugh Contact Phone: 256 772-
9321 Party/Vendor Address: 453 Lanier Rd City Madison State: AL Zip: 35758 Department: Emergency
Services Amount: $247,193.20 Purpose: Ambulance Remount 0840 and #813) Budget Code(s): 61757535-
802000-30010 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 FYI 8-19,BOCC Meeting 1/22/2019
This agreement is approved as to technical form and content and I as Department Director affirmatively state work
on this project has not been initiated prior to execution of the agreement:
DocuSigned by:
,�t.,�V'tt,S
Department Director's SignatureFvt"� Date: 2/5/2019
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that
was addressed:
Information Technologies
(Applicable only to hardware/software purchases and 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 sufficienc ®wawstandards,specifications,and requirements:
gusa nu,1T0 2/6/2019
Office of the Risk Management Office Date:
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 lq.-N O.��1. Date: 2/13/2019
Legal Services
This agreement is approved as t .1cffl fdaWd sufficiency:
2/14/2019
Office of the County Attorney 1,6VK_ 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:
Revised 12/18 8