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DocuSign Envelope ID: CCFF6125- AA47- 438A- 98CA- B42519499D42 <br />ORANGE COUNTY - DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: Piedmont Health Services Party/Vendor Contact Person: Brian Toomey Contact Phone: 919- <br />933 -8494 Party/Vendor Address: 127 Kingston Drive City Chapel Hill State: NC Zip: 27514 Department: Finance <br />& Administrative Services Amount: 16500 Purpose: FY 2018 -19 Outside Agency /Human Services Performance <br />Agreeement Budget Code(s): 10495050- 719021 Vendor # 27898 (N /A if new vendor) Vendor is a BOCC <br />consultant? Yes ❑ No❑ Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date <br />7/1/2018 Approved by Board Yes[] No❑ Agenda Date: 6/19/2018 <br />This agreement is approved as to technical for i)ocusigned by: <br />8/23/2018 <br />Department Director's Signature Date: <br />704E5181ACC1409... <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 />This agreement is approved for sufficiency of in, DocuSigned by: <br />Office of the Risk Management Officer 7F6CF917E800498... <br />Financial Services <br />This instrument has been pre- audited in them oocu5igned by: <br />Office of the Chief Financial Officer 704E5181ACC1409... <br />Legal Services <br />This agreement is approved as to legal formC�4035CB8'304CA4M... <br />ocuSigned by: <br />4k�1,,w� <br />Office of the County Attorney <br />Clerk to the Board <br />Date: <br />;cifications, and requirements: <br />8/24/2018 <br />Date: <br />al Government Budget and Fiscal Control Act: <br />Date: 8/23/2018 <br />Date: <br />8/24/2018 <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 />(Piedmont Health Services) <br />Orange County Outside Agency Performance Agreement Page 6 of 9 <br />Rev. 7118 <br />