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DocuSign Envelope ID: 7055CF95-11 1 F-4521-91 ED-AAC3F4F34D28 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: EmPOWERment, Inc. Party/Vendor Contact Person: Delores Bailey Contact Phone: 919967- <br /> 8779 Party/Vendor Address: 109 N. Graham Street 4200 City Chapel Hill State: NC Zip: 27516 Department: <br /> Finance & Adm. Srv. Amount:$ 20,000 Purpose: Outside Agency Performance Agreement Budget Code(s): <br /> 10495050 789005 Vendor 4 800065 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ NoX Contract <br /> Type: (Check one)New ❑ Renewal ❑ Amendment ❑ Effective Date July 1,2015 Approved by Board YesX <br /> No❑ Agenda Date: June 16,2015 <br /> This agreement is approved as to technic form bpd content: <br /> ocuSigned by: <br /> Department Director's Signature <br /> �q blti Date: 10/2/2015 <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 sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned""by: <br /> ''1L <br /> Q�As& r,6vvt,e b 10/1/2015 <br /> Office of the Risk Management Officer Date: <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by. <br /> Office of the Chief Financial Officer <br /> bVu Date: 10/2/2015 <br /> 232DFFC2CFA847B... <br /> Legal Services <br /> This agreement is approved as to le a�fo n daufficiency: <br /> Office of the County Attorney I ✓A Date: 10/5/2015 <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 /> (EmPOWERment,Inc) <br /> Orange County Outside Agency Performance Agreement Page 6 of 7 <br /> Rev. 6115 <br />