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DocuSign Envelope ID: C33B4E4E-6357-44A2-8A64-68BO07EOF277 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Flaircare dba Homewatch CareGivers Party/Vendor Contact Person: Anzor Gachechiladze <br /> Contact Phone: 919-960-6038 Party/Vendor Address: 101 Cosgrove Ave., Ste 120 City Chapel Hill State: NC Zip: <br /> 27514 Department: Aging Amount: $14,700 Purpose: in-home services Budget Code(s): 10432020-630105 Vendor <br /> # 53657 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ <br /> Renewal® Amendment ❑ Effective Date Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Docu5igned by: <br /> Department Director's Signature ,WAA*a. :�(.W Date: 8/24/2016 <br /> 67E962D1BF454FA... <br /> Information Technolosies <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: 11i1 <br /> Office of the Risk Management Officer allSA. ('6nA '',ll b Date: 8/25/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in h &N %quired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer el-m °'� Date: 8/25/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> igned by: <br /> Office of the County Attorney DocuS Date: 8/26/2016 <br /> 4035CE8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.gov <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 /> Revised 6/16 5 <br />