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DocuSign Envelope ID: DBE71181-5A2C-4DC5-B867-8C8C1FCB2DCF <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Charles House Association Party/Vendor Contact Person: Contact Phone: <br /> Party/Vendor Address: 7511 Sunrise Road City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: <br /> 8000.00 Purpose: Adult Daycare services Budget Code(s): 10432020-630100 and 630105 Vendor# 19446 (N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal <br /> Amendment ❑ Effective Date Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> Docusigned by: <br /> Department Director's Signature D. <br /> Date: 7/10/2019 <br /> B7E962D1BF454FA.. <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: <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 sufficient rD'ocusigned by:" ' rds,specifications,and requirements: <br /> Office of the Risk Management OfficerlUSa CbVln.tAb Date: 7/10/2019 <br /> 7FDCF91768004M <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: Docusigned by: <br /> 41 .e.4ra. 7/10/2019 <br /> Office of the Chief Financial Officer Date: <br /> 7n4E51S1ACC1409. <br /> Legal Services <br /> This agreement is approved as to lega' " Docusigned by: <br /> Office of the County Attorney •�°'"' - Date: 7/11/2019 <br /> 4035CB8304CA4M <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@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 12/18 <br /> 8 <br />