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DocuSign Envelope ID:20CF096F-CA74-409A-B90A-94B182005E1 E <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Senior Care Party/Vendor Contact Person: Alvonia Baldwin Contact Phone: <br /> Party/Vendor Address: 105 Meadowlands Drive City Hillsborough State: NC Zip: 27278 Department: Aging <br /> Amount: $12,000 Purpose: respite services Budget Code(s): 10432020-630105 Vendor 4 19446 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ <br /> Effective Date July 1,2015 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature � « � Date: 6/26/2015 <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: <br /> ''111L <br /> Office of the Risk Management Officer a�lSa (,bnU& Date: 6/29/2015 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in th fA jdtVquired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer PMAL tA+bVu Date: 6/29/2015 <br /> 232DFFC2CFA847B... <br /> Legal Services <br /> This agreement is approved as to le a�f��rsmn sufficiency: <br /> Office of the County Attorney ✓ 0 1� Date: 6/29/2015 <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 />