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DocuSign Envelope ID: 57FEBA8F-F3CB-4E27-8449-89742020C9FA <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: Chapel Hill-Carrboro YMCA- Boomerang Party/Vendor Contact Person: Kim Grooms <br /> Contact Phone: 919-442-9622 Party/Vendor Address: 980 Martin Luther King Jr. Blvd. City Chapel Hill State: NC <br /> Zip: 27514 Department: Finance & Adm. Srv. Amount:$ 5,000 Purpose: Outside Agency Performance Agreement <br /> Budget Code(s): 10495050 719047 Vendor 4 800057 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ <br /> NoX Contract Type: (Check one)New ❑ Renewal ❑ Amendment ❑ Effective Date July 1,2015 Approved by <br /> Board YesX No❑ Agenda Date:June 16,2015 <br /> This agreement is approved as to tec ' b9n ,:content: <br /> Department Director's Signature �,AIAbIn, Date: 7/28/2015 <br /> 232DFFC2CFA847B... <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 sufficient �1,,7gys''t�1andards,specifications,and requirements: <br /> Q�.SA. r,6vvt,e; 7/28/2015 <br /> Office of the Risk Management Officer F Date: <br /> Financial Services <br /> This instrument has been pre-audited in t M gAequired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer ' Date: 7/28/2015 <br /> 232DFFC2CFA847B... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DOCUSigned by: <br /> 7/28/2015 <br /> Office of the County Attorney Date: <br /> 4035CB83046A4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloydLvorm-1gecolintync.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 /> (Chapel Hill-Carrboro YMCA-Boomerang) <br /> Orange County Outside Agency Performance Agreement Page 6 of 7 <br /> Rev. 6115 <br />