Orange County NC Website
Browse       Search
DocuSign Envelope ID:AF4EB7D3-2ECB-4572-BEB5-A7B57F5BAA00 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone: <br /> Party/Vendor Address: 7511 Sunrise Rd City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: $6,600 <br /> Purpose: adult day care services Budget Code(s): 10432020-630100 Vendor# 19446 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective <br /> Date 8/20/17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> /^--DocuSigned by: <br /> Department Director's Signature i .tGt- � t V Date: <br /> 8/24/2017 <br /> B7E962D1BF454FA... <br /> Information Technologies <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 insurance standards, specifications, and requirements: <br /> r---DocuSigned by: <br /> aLtS& Cb b 8/25/2017 <br /> Office of the Risk Management Officer Date: <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> , ---DocuSigned by: <br /> Office of the Chief Financial Officer Date: 8/25/2017 <br /> —7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> p--DocuSigned by: <br /> County Attorney al�UA.t, hark, fibSGb 8/25/2017 <br /> Office of the Coun Attorne Date: <br /> `—079A4D525C0F4FB... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.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 /> Revised 2/17 5 <br />