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Docunign Envelope ID:ABmeoc1-8309-4o41-B52n-6E84ro73FAA6 <br /> ATTACHMENT "A" <br /> Orange County Certifications—F1' 20]6-|7 <br /> Outside Agency Performance Agreement <br /> Chief Contact Administrators,Chief, <br /> \oertifv that I have provided u list of the chief contact.udmiois�unr `ch�texeuut�eoffiucrundohief <br /> �nunci�u] officer for my agency with this Agreement and that| will keep k current tu the County ofOrange. <br /> The list should be in writing with the name,title, residential address; phone and email address and if <br /> possible, fax number. <br /> Officers and Board of Directors <br /> I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and <br /> that we will continue to update the list as changes occur. The list should be in writing,with the name, <br /> physical address, mailing address and if possible,phone, fax and email address. <br /> Budget Submission <br /> I certify that I have provided a budget for the period to be covered by funding Orange County, and that any <br /> substantive changes made to this budget have been in advance authorized in writing by Orange County. <br /> Annual Financial Review <br /> I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget <br /> adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a <br /> separate sheet of paper. <br /> Alignment with Organization's Mission <br /> T certi that the programs and services for which this funding is requested align with the mission of the <br /> organization. <br /> Intended Purpose <br /> I certify that the funds provided to the agency under the terms of this Agreement will be used for a public <br /> purpose and shall only be used for the purposes intended and any money not used for those purposes will be <br /> promptly returned to Orange County. <br /> o"""»m"°^^'' <br /> county Di rector 2/9/2017 <br /> Certified hy: � Ti\l�� Date: <br /> (Provider's Signature) <br /> rthoo'eligoge club's Fail*(01(erfOi4ilorPonce) <br /> Orange County Outside Agency Performance Agreement <br /> Rev 8 16 <br />