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<br />ATTACHMENT "A" <br />Orange County Certifications - FY 2010 <br />Freedom House Recovery Center Performance Agreement <br />Chief Contact, Administrators, Chief Executive Officer and Chief Financial Officer <br />I certify that I have provided a list of the chief contact, administrators, chief executive <br />officer and chief financial officer for my agency with this Agreement and that I will keep <br />it current to the County of Orange. The list should be in writing with the name, title, <br />residential address; phone and email address and if possible, fax number. <br />Officers and Board of Directors <br />I certify that I have provided a current list of the Officers and Board of Directors with this <br />Agreement and that we will continue to update the list as changes occur. The list should <br />be in writing, with the name, physical address, mailing address and if possible, phone, fax <br />and email address. <br />Budget Submission <br />I certify that I have provided a budget for the period to be covered by funding Orange <br />County, and that any substantive changes made to this budget have been in advance <br />authorized in writing by Orange County. <br />Annual Financial Review <br />I certify that I have provided a copy of the latest annual Financial Review for our agency <br />and the budget adopted by the agency for the fiscal years encompassing this Agreement. <br />If not, please explain on a separate sheet of paper. <br />Alignment with Organization's Mission <br />I certify that the programs and services for which this funding is requested align with the <br />mission of the organization. <br />Intended Purpose <br />I certify that the funds provided to the agency under the terms of this Agreement will be <br />used for a public purpose and shall only be used for the purposes intended and any money <br />not used for those purposes wile promptly returned to Orange County. <br />_..... ~ n ,., <br />/ ; ,.r <br />r ~'`' x~ ~ <br />Certified by. - - , - ~, ' Title: ~ ~ ~,~~ c ~ Date: 3 ! ~ ZD~~ <br />F~zedom House Recovery Center <br />Orange County Agency Performance Agreement <br />Page 10 of 10 <br />