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DocuSign Envelope ID:A3E0213B-1DCD-43A3-9C41-A2EC55A8CA94 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Orange Congregations in Mission-Samaritan Relief Ministry Party/Vendor Contact Person: <br /> Rev. Sharon S. Freeland Contact Phone: (919) 732-6194 x10 Party/Vendor Address: 300 Millstone Drive City <br /> Hillsborough State: NC Zip: 27278 Department: Finance & Administrative Services Amount: 33415 Purpose: <br /> Outside Agencies Funding Budget Code(s): 10495050-710031 Vendor# 800010 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes❑No❑ Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date <br /> 7/1/16 Approved by Board Yes®No❑ Agenda Date: 6/21/16 <br /> This agreement is approved as to technical forma cdR"ft_.ned by: <br /> Department Director's Signature 4R,A ,4� Date: <br /> Information Technolo0es <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 insur g4md wdsy-specifications,and requirements: <br /> Qusa. CV'lnd O 6 <br /> Office of the Risk Management Officer 71MCE91268004g� Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner r IW�Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer � Date: <br /> n.CCa ar�4 <br /> Legal Services <br /> This agreement is approved as to legal form and su ' -DooGsigned by: <br /> ff <br /> Office of the County Attorney 4�,q 4,_ Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecount.ny_c.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 /> (Orange Congregations in Mission-Samaritan Relief Ministry) <br /> Orange County Outside Agency Performance Agreement <br /> Rev. 8116 <br />