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DocuSign Envelope ID:E8163127-982F-4CDF-AAFE-9EAE17837984 <br /> ATTACHMENT "A" <br /> Orange County Certifications <br /> Outside Agency Performance Agreement <br /> Chief Contact,Administrators, Chief Executive Officer and Chief Financial Officer <br /> I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief <br /> financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. <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 separate <br /> sheet of paper. <br /> Alignment with Organization's Mission <br /> I certify 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 <br /> be promptly returned to Orange County. <br /> Transparency <br /> I certify that board meetings are open to the public with the exception of closed session meetings. <br /> Additionally, all financial records are available for public inspection by request upon reasonable notice. <br /> DocuSigned by: <br /> �i5ric irt, --"obtMU1 8/16/2017 <br /> Certified by: FRRRARFCR117WR Title: Date: <br /> Piedmont Health Services,Inc. <br /> Orange County Performance Agreement <br /> Page 8 <br /> Rev. 7/2017 <br />