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DocuSign Envelope ID:6D51`41 E3-E7E2-4D6C-l3E76-951 E8674450E Contract#68-2040 <br /> Charles House Association <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Charles House Association PartyfVendor Contact Person: Paul Klever Contact Phone: (919) 967-7570 <br /> Party/Vendor Address: 7511 Sunrise Rd, City Chapel Hill State: NC Zip: 27514 Department: Social Services Amount: $24,000 <br /> Purpose:Adult Day Care Budget Codes): 10405020-764100&1 0405020-764 101 Vendor#19446 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ NoN Contract Type: (Check one)New❑ Renewal Z Amendment ❑ Effective Date July 1.2018 <br /> Approved by Board Yes❑NoZ Agenda Date: <br /> This agreement is approved as to te, Docu5igned by: tent: <br /> N bim 12/5/2018 <br /> Department Director's Signature Date: <br /> DAE1E196A83B455... <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to <br /> information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiene -6ocu5igned by: �t ' rds,specifications,and requirements: <br /> Office of the Risk Management OfficerQuSa �,bVlrt.f,lib 7FDCF9176800498... Date:11/5/2018 <br /> Financial Services <br /> This instrument has been pre-audited' Docusigned by: the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer 4� Date:12/7/2018 <br /> 704E5181ACC1469... <br /> Le-aal Services <br /> This agreement is approved as t Docusigned by: :ncy: <br /> 12/7/2018 <br /> Office of the County Attorneyp35C68304CA4A9... Dale.. <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@oyangecouMnc.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 /> Contract-General (07/10) Page 5 of <br />