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DocuSign Envelope ID: BF4D7555-FC71-4DF1-810C-FC302E35CC4B <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: Charles House Party/Vendor Contact Person: Paul Klever Contact Phone: Party/Vendor <br /> Address: 109 Hillcrest Avenue City Carrboro State:NC Zip: 27510 Department: Aging Amount: $12,000 Purpose: <br /> respite services Budget Code(s): 10432020-630105 Vendor 4 19446 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 1, <br /> 2015 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to techni^ of9e content: <br /> Department Director's Signature , AJJUU- Ty�-r Date: 6/24/2015 <br /> B7E962D1BF454FA... <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned""by:''1L <br /> Paustu r,6n tt0 6/25/2015 <br /> Office of the Risk Management OfficerDate: <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in t 13�g A TgRuired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer PAUL, ['"-+6VU Date: 6/25/2015 <br /> 232DFFC2CFA847B... <br /> Legal Services <br /> This agreement is approved as to le &fQM1gn4:sufficiency: <br /> Office of the County Attorney 1� Date: 6/25/2015 <br /> 4035CB8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/14 4 <br />