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DocuSign Envelope ID: 51CB0066-1185-4FDA-AC7B-8ClF27F6013F Contract#68-2009 <br /> Charles House Association <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Departmen <br /> Party/Vendor Name: Charl,-s Hou��—Association Party/Vendor Contact Person: Laul_Klever Contact Phone: (919) )67-7570 <br /> Party/Vendor Address: 109_14iliCrestAssOciation City�jarrboro State:NC Zip:275 10 Department: Social—Services Aniount: $25�O00 <br /> Purpose:Adult_Day Care Budget Code(s): 10405020-764 100 Vendor# 19446 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes F-I NoE Contract Type:(Check one)-�ew_Ej Ren—ewal E Amendment [I Effective Date jqly I_20 16 Approved by Board Yes <br /> E] NoZ Agenda Date:_ <br /> This agreement is approved as to technical form a. tp <br /> ,qj$qed by: <br /> N" 66st6w 8/25/2016 <br /> Department Director's Signature tl -5�­----Date:— <br /> r&AE4E496Ae3B4 <br /> Information Technolo2ies <br /> (Applicable only to hardwarelsoftware purchases or related services)This agreement has been reviewed and is approved as to <br /> information technology content and specifications: <br /> Office of the Chief information Officer Date: <br /> Risk Managemen <br /> This ap <br /> ,reement is approved for sufficiency of insurance i&Wsnp"cifications,and requirements: <br /> 8/22/2016 <br /> Office of the Risk Management Officer—_.- Date, <br /> Financial Services <br /> This instrument has been pre-audited in the manner r 'Pe6b5ntlhoLocal Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: 8/25/2016 <br /> kGC44G9­­__ .......- <br /> Legal Services <br /> This agreement is approved as to legal form and suffi �usigned by: <br /> Date: 8/26/2016 <br /> Office of the County Attorney 9-'­­_ <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion(aD Dgil()Id(.diorangecoLintvne.aoN, <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 <br /> Contract-General (07/10) Page 5 of 5 <br />