R 2015-320-E DSS - Charles House Association to provide adult day services to OC DSS clients

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DocuSign Envelope ID:27BE0809-07F1-4358-A397-lF35DD236252 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone: (91 967-7570 Party/Vendor Address: 109 Hillcrest Ave City Carboro State: NC Zip: 27510 Department: DSS Amount: $25,000 Purpose: Provide Adult Day Services„to clients of Orange County DSS Budget Code(s): 10405020-764100 Vendor# 19446 (NIA if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 07/01/15 Approved by Board Yes® No❑ Agenda Date: This agreement is approved as to technical form Ettgited by: NAArt G� �,OSf01� Department Director's Signature Date: 6/30/2015 Information Technologies (4pplicahle only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance ,} g§lbhp' 6 eecfcications, and requirements: Office of the Risk Management Officer PUS& 66Vlit Date: 6/30/2015 WNUT- Financial Services This instrument has been pre-audited in the manner required by the Local. Government Budget and Fiscal Control Act: DocuSigned by: Office of the Chief Financial Officer PMA �'""D"" bin, Date: 7/7/2015 Legal Services This agreement is approved as to legal form and eiyg by: Office of the County Attorney - �l � Date: 7/7/2015 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dollo rdnoran ecount ,nc. ov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: