R 2016-604-E Finance - Duke HomeCare & Hospice - Outside Agency Performance Agreement

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DocuSign Envelope ID:38357F45-OFD1-474F-992F-A2DODA42A3E2 ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Duke HomeCare & Hospice Party/Vendor Contact Person: BelleStarr Browning Contact Phone: 919-479-0318 Party/Vendor Address: 4321 Medical Park Drive, Suite 101 City Durham State: NC Zip: 27704 Department: Finance &Administrative Services Amount: 1000 Purpose: Outside Agencies Funding Budget Code(s): 10495050-710026 Vendor# 50707 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 7/1/16 Approved by Board Yes ®No❑ Agenda Date: 6/21/16 This agreement is approved as to technical forma cAfeWP"by: Department Director's Signature Date: Information Technologies (Applicable only to hardwarelsoftware purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insuran W &�,:pecifieations,and requirements: Office of the Risk Management Officer FDeaea Date: Financial Services This instrument has been pre-audited in the manner rc l26"T Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer �,o ,onam Date: Legal Services This agreement is approved as to legal form and suf pjVsignea by: Office of the County Attorney 44J4 4 Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd&orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: (Duke HomeCare&Hospice) Orange County Outside Agency Performance Agreement Rev. 8116