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DocuSign Envelope ID:2164F437-BF9D-46A1-B13B-7740B02003DA <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Boys& Girls Club of Eastern Piedmont Party/Vendor Contact Person: Sarah Marion Contact <br /> Phone: 919-663-6159 Party/Vendor Address: 288 East Street, Suite 1008 City Pittsboro State: NC Zip: 27312 <br /> Department:Finance&Administrative Services Amount: 5000 Purpose: Outside Agencies Funding Budget Code(s): <br /> - Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one)New <br /> ® Renewal ❑ Amendment ❑ Effective Date 7/1/16 Approved by Board Yes[] No❑ Agenda Date: <br /> 6/21/16 <br /> This agreement is approved as to technical fo MA"tby: <br /> Department Director's Signature re, Date: 11/3/2016 <br /> p g nn Gsa.�a n.��a arm... <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 /sta�i ; s ecifications,and requirements: <br /> QUSA. r,0b 11/4/2016 <br /> Office of the Risk Management Officer �FOCFS,�ssoo4s8... Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner r 'fL&0j9nt MyLocal Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer 7 Date: 11/3/2016 <br /> �B&Er1S4RC6'409... <br /> Legal Services <br /> This agreement is approved as to legal form and s CL�";ed by:�� 11/4/2016 <br /> Office of the County Attorney �a� D Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecount.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 /> (Boys &Girls Club of Eastern Piedmont) <br /> Orange County Outside Agency Performance Agreement <br /> Rev. 8116 <br />