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DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA <br />ORANGE COUNTY — DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: Boys & Girls Club of Durham & Orange Counties Party/Vendor Contact Person: Jerome <br />Levis y Contact Phone: 919 - 687 -4517 Party/Vendor Address: 808 East Pettigrew Street; PO BOX 446 City Durham <br />State: NC Zip: 27702 Department: Finance & Administrative Services Amount: 5000 Purpose: FY 2018 -19 Outside <br />Agency /Human Services Performance Agreeement Budget Code(s): 10695050- 719055 Vendor # 800171 (N /A if <br />new vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) New ® Renewal ❑ <br />Amendment ❑ Effective Date 7/1/2018 Approved by Board Yes ®No❑ Agenda Date: 6/19/2018 <br />This agreement is approved as to technical form DocuSigned by: <br />8/16/2018 <br />Department Director's Signature Date: <br />------ 81ACC1:a09... <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 <br />Risk Management <br />Date: <br />This agreement is approved for sufficiency of in DocuSigned by: ' - cifications, and requirements: <br />US& (,b�6 8/17/2018 <br />Office of the Risk Management Officer 117FDCF9176-900498 Date: <br />Financial Services <br />This instrument has been pre- audited in the mann DocuSigned ay: 3overnment Budget and Fiscal Control Act: <br />8/16/2018 <br />Office of the Chief Financial Officer 7DaE51a1ACC,40s... Date: <br />Legal Services <br />This agreement is approved as to legal form and DocuSigned by: <br />y <br />Office of the County �' �'� Date: 8/17/2018 <br />` y 4035CB8304CA4M... <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersoll upon completion @ sin erg sollgoran eg countync. og_v <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 />(Boys & Girls Club of Durham & Orange Counties) <br />Orange County Outside Agency Performance Agreement Page 7 of 9 <br />Rev. 7118 <br />