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DocuSign Envelope ID:935E5DF2-2E44-4828-901E-8C6C6A7DFAE8 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: Planned Parenthood South Atlantic Party/Vendor Contact Person: Doug Jackson, Interim <br /> President and CEO Contact Phone: 919-833-7534 x251 Party/Vendor Address: 1765 Dobbins Drive City Chapel <br /> Hill State: NC Zip: 27514 Department: Finance & Adm. Srv. Amount:$ 20,000 Purpose: Outside Agency <br /> Performance Agreement Budget Code(s): 10495050 710013 Vendor 4 800040 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑NoX Contract Type: (Check one)New ❑ Renewal ❑ Amendment ❑ Effective Date <br /> July 1,2015 Approved by Board YesX No❑ Agenda Date:June 16,2015 <br /> This agreement is approved as to techni&al12m and content: <br /> ocu igne by: <br /> 9/29/2015 <br /> Department Director's Signatur blti Date: <br /> Ci232DFFC2CFA847B <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:''11LL <br /> Office of the Risk Management Officer rius. (,bvvt e& Date: 9/25/2015 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in iNquired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer PMAL t'"-+bVu Date: 9/29/2015 <br /> 232DFFC2CFA847B... <br /> Legal Services <br /> This agreement is approved a to le aU, fficiency: <br /> Office of the County Attorney ✓ Date: 9/29/2015 <br /> 4035CB8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd yorangecou 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 /> (Planned Parenthood South Atlantic) <br /> Orange County Outside Agency Performance Agreement Page 6 of 7 <br /> Rev. 6115 <br />