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DocuSign Envelope ID:B32F3E9F-996A-4000-8CAF-83514F2E5759 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: TABLE Party/Vendor Contact Person: Ashton Tiepins Contact Phone: 919-636-4860 <br /> Party/Vendor Address: 205 West Weaver Street City Carrboro State: NC Zip: 27510 Department: Finance & <br /> Administrative Services Amount: 5000 Purpose: Outside Agencies Funding Budget Code(s): 10495050-720116 <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: 6/21/16 <br /> This agreement is approved as to technical forma KdTRfftft ed by: <br /> 0.&& 11/9/2016 <br /> Department Director's Signature Date: <br /> Information Technologies <br /> (Applicable only to hardwarelsoftware 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 (A"i specifications,and requirements: <br /> EAF791105004 so, (hnut l6 11/11/2016 <br /> Office of the Risk Management Officer a � Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner ce iire�sbgytle li��Local Government Budget and Fiscal Control Act: <br /> 16.& <br /> Office of the Chief Financial Officer oaa,ncc1aos... Date: 11/9/2016 <br /> Legal Services <br /> This agreement is approved as to legal form and @4ey i� ed by: <br /> 11/11/2016 <br /> Office of the County Attorney Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dollo,d a oran eg countyne. oovv <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 /> (TABLE) <br /> Orange County Outside Agency Performance Agreement <br /> Rev. 8116 <br />