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DocuSign Envelope ID: 3FD37DED-3EFC-49BB-BD08-D6EFCA4FEB76 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: Senior Care of Orange County, Inc Party/Vendor Contact Person: Alvonia Baldwin Contact <br /> Phone: 919-245-2017 Party/Vendor Address: 105 Meadowland Drive City Hillsborough State: NC Zip: 27278 <br /> Department: Finance & Adm. Srv. Amount:$ 25,000 Purpose: Outside Agency Performance Agreement Budget <br /> Code(s): 10495050 719027 Vendor 4 800047 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ NoX <br /> Contract Type: (Check one)New ❑ Renewal ❑ Amendment ❑ Effective Date July 1,2015 Approved by Board <br /> YesX No❑ Agenda Date:June 16,2015 <br /> This agreement is approved as to technic form d content: <br /> ocu$igned-by: <br /> VU Date: 8/23/2015 <br /> Department Director's Signature <br /> b <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 sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned""by: <br /> ''1L <br /> Q�As& r,6vvt,e b 8/21/2015 <br /> Office of the Risk Management Officer Date: <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in �gjdi:Wuired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer �Adti� haw Date: 8/23/2015 <br /> 232DFFC2CFA847B... <br /> Legal Services <br /> This agreement is approved as to le al orr�q ark sufficiency: <br /> ocu igne y: <br /> Office of the County Attorney ✓- � Date: 8/24/2015 <br /> 4035CB8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou 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 /> (Senior Care of Orange County,Inc) <br /> Orange County Outside Agency Performance Agreement Page 6 of 7 <br /> Rev. 6115 <br />