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DocuSign Envelope ID: 1582AE24-D793-4A66-9311-4472000BOEC3 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Personalized Patient Borne Assistance Inc. Party/Vendor Contact Person: Dorothy <br /> Farrington Contact Phone: (919) 929-4943 Party/Vendor Address: 109 Concord Dr City Chapel Hill State: NC <br /> Zip: 27516 Department: DSS Amount: $75,000 Purpose: Provide em to :ees to perform in-home services for <br /> OCDSS clients Budget Code(s): 10400220-630000 Vendor 9 58844 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment <br /> 07/01/15 Approved by Board Yes®No❑ Agenda Date: [I Effective Date <br /> This agreement is approved as to technical fo ttht; <br /> f�a.y ed,$7-0 <br /> Department Director's Signature Dad/16/2015 <br /> Information Technolo2jes <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 Mana ement <br /> This agreement is approved for sufficiency of insura andisf*,bripecifications, and requirements: <br /> 17�,EDCE917Q6QQ498_ISa, 66vvt,e 6 7/14/2015 <br /> Office of the Risk Management Officer Da te: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officer PXAL to D""`bvu 7/16/2015 <br /> ae��sas�aa4zA Date: <br /> Legal Services <br /> This agreement is approved as to legal form and figi a by: <br /> 7/16/2015 <br /> Office of the County Attorney 4� l 1� Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dollo =dLworangecount ync. ov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br />