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DocuSign Envelope ID: 10E673C3-E710-42EA-A3C9-4B338A28EADF <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> NOT A CONTRACT EXHIBIT OR ATTACHMENT <br /> Department <br /> Party/Vendor Name: Bethesda Care, L.L.0 dba Keston Care Party/Vendor Contact Person: Roxanne Kessler Contact <br /> Phone: (919)967-0507 Party/Vendor Address: 1 1312 US 15-501,Chatham Crossing Suite 400 City Chapel Hill State: <br /> NC Zip: 27517 Department: Social Services Amount: $10,00 0 Purpose: RN Services Budget Code(s): <br /> Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New <br /> ® Renewal ❑ Amendment ❑ Effective Date March 30, 2015 Approved by Board Yes❑ No® Agenda <br /> Date: <br /> This agreement is approved as to technical forma p.ned by: <br /> NAB �"StbIA' 6/11/2015 <br /> Department Director's Signature E_4 <br /> ea.�14)Zb183B45� Date: <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 Director of Information Technology Date: <br /> Risk Management <br /> This agreement is approved for sufficiency 7FDf_F91:T&8Q0498 a-j � "& specifications, and requirements: <br /> sa, r,6m,&b 6/12/2015 <br /> Office of Risk Management Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manne a rb �e Local Government Budget and Fiscal Control Act: <br /> �A [A <br /> .Ut, .U� 6VU <br /> Office of the Chief financial Officer Date: 6/29/2015 <br /> DFF <br /> Legal Services <br /> This agreement is approved as to legal form and su euSigned by: <br /> Office of the County Attorney -�� Date: 6/29/2015 <br /> Clerk to the Board <br /> Received for record retention: oocuSigned by: <br /> f?at V <br /> rNMAA <br /> Office of the Clerk to the Board Date: 6/30/2015 <br /> TE6Taar-eQ9z®41DF... <br /> Revised 7114 4 <br />