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DocuSign Envelope ID:90C1 B51 E-E878-48B8-B980-2C934FC73BAD <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> NOT A CONTRACT EXHIBIT OR ATTACHMENT <br /> Department <br /> Party/Vendor Name: Happy Homecare Staffing, Inc. Party/Vendor Contact Person: Lesa Kendrick Contact Phone: <br /> (919) 732-4663 Parry/Vendor Address: 6720 Pentecost Road City Cedar Grove State: NC Zip: 27231 Department: <br /> Social Services Amount: $10,000 Purpose: RN Services Budget Code(s): Vendor 9 N/A (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 formr_N c%Te?jjgnedby: <br /> Department Director's Signature st6vu Date: 6/11/2015 <br /> Information Technologies <br /> (Applicable only to hardtivarelsofhvare 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 of insur Dsegiid + s ecifications,and requirements: <br /> Q�1Sa rbb 6/12/2015 <br /> Office of Risk Management zEncEa1ZBAA04gp Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner aa�tg�llke:Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer P Date: 6/29/2015 <br /> Legal Services <br /> This agreement is approved as to legal form and suff ciency signea by: <br /> 1 6/29/2015 <br /> Office of the County Attorney Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised 7114 4 <br />