HomeMy WebLinkAboutR 2019-777 Health - LifeLine mobile dental unit DocuSign Envelope ID:A18808EO-5F70-4494-BCOC-49B95D82162D
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: LifeLine Mobile,Inc. Party/Vendor Contact Person: Karyn Prater Contact Phone: 614-497-
8300 x104 Party/Vendor Address: 2050 McGaw Rd. City Columbus State: OH Zip: 43207 Department: Health
Amount: $445,748 Purpose: Provide Mobile Dental Clinic per specificiations Budget Code(s): 61370035-802000-
30012 Vendor# 65761 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type:
(Check one)New ® Renewal ❑ Amendment ❑ Effective Date 10-17-19 Approved by Board Yes®No❑
Agenda Date: 10-15-19
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:
S�_Wof 10/17/2019
Department Director's Signature[3C16F2n09E3445F. Date:
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 coi h Decusigned by: ins:
1t� 44yvf 10/17/2019
Office of the Chief Information Officer c1aa91E73Ae4DF.. Date:
Risk Management
This agreement is approved for sufficiency Docu5igned_by:
. Is,specifications,and requirements:
aUsa CbVln.t,{�6 10/18/2019
Office of the Risk Management Officer 7F❑CF9170800498. Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: Docu5igned by:
('1) '�' � 10/21/2019
Office of the Chief Financial Office 7NE518,Acc,400. Date:
Legal Services
This agreement is approved as t DocuSigned by: iciency:
, 6t Pklvf5 10/21/2019
Office of the County Attorney EAAM33EMA@405.. 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 9