R 2017-150-E Health - Refugee Support Center - Outside Agency Performance Agreement

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DocuSign Envelope ID:6661FF62-5F0B-4B97-9C2E-09BCC224B580 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Refugee Support Center Party/Vendor Contact Person: Flicka Bateman Contact Phone: 919- 423-1478 Party/Vendor Address: PO Box 1025 City Carrboro State: NC Zip: 27510 Department: Health Amount: $11,340.00 Purpose: Refugee support services Budget Code(s): Social Justice Funds Vendor# 62967 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 4-4-17 Approved by Board Yes No Agenda Date:4-4-17 This agreement is approved as to t ° ' �i� e �d� �coQntent: OV'0 UluVtZt 4/25/2017 Department Director's Signature 5145n2CD945c40F... Date: Information Technologies (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 sufficient d r e_eys'taandards,specifications,and requirements: aMtSA. rbvvutl0 5/2/2017 Office of the Risk Management Officer Date: �Feere17c5oo495... Financial Services This instrument has been pre-audited i r, oratlitnell'required by the Local Government Budget and Fiscal Control Act: (71.4., ��n 5/4/2017 Office of the Chief Financial Officer ' Date: Legal Services This agreement is approved as t e crth'MY�ni`',,g�ii.i-�sufficiency: '1' r` t1' SCb 5/5/2017 Office of the County Attorney 07Q4d1152FrOF4FR 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: Orange County Outside Agency Performance Agreement—Social Justice Funds Page 6 of 7 April 2017