R 2016-619-E Finance - Planned Parenthood South Atlantic - Outside Agency Performance Agreement

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DocuSign Envelope ID: CBOC1343-06EB-4BE7-9AF6-62EE77BD69FE ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Planned Parenthood South Atlantic Party/Vendor Contact Person: Jenny Contact Phone: 919-833-7526 x6140 Party/Vendor Address: 1765 Dobbins Drive City Chapel Hill State: NC Zip: 27514 Department: Finance & Administrative Services Amount: 20000 Purpose: Outside Agencies Funding Budget Code(s): 10495050-710013 Vendor# 800040 (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 ®Nor-1 Agenda Date: 6/21/16 This agreement is approved as to technical forma Njtft-d by: Department Director's Signature t� nnG�, Date: Information Technolo0es (Applicable only to hardware/software 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 t&UdW4s,bspecifications,and requirements: aura. COV'lnd 6 Office of the Risk Management Officer 7F0Cf94jZ8004N Date: Financial Services This instrument has been pre-audited in the manner r qui T i�yLocal Government Budget and Fiscal Control Act: Office of the Chief Financial Officer rmn Date: naFS�g�nrr�anq Legal Services This agreement is approved as to legal form and suf cleignea by: Office of the County Attorney nar D Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecount.nic.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: (Planned Parenthood South Atlantic) Orange County Outside Agency Performance Agreement Rev. 8116