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DocuSign Envelope ID: FBA030F0-9120-42B9-A272-5932D959B8F6 Contract#68-2042 <br /> Charles House <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone:919-967-7570 Party/Vendor <br /> Address:7511 Sunrise Road City Chapel Hill State:NC Zip:27514 Department:Social Services Amount:$24,000 Purpose:adult day <br /> care Budget Code(s): 10405020-764100& 10405020-764101 Vendor 9 19446 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑No® Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date July 1,2019 Approved by Board <br /> Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not <br /> been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> Noun c� rbS�b�t Date:7/9/2019 <br /> Department Director's Signature <br /> oxcE-rs1 ssxsasa <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have <br /> already begun or been completed please briefly describe the nature of the emergency condition that was addressed: <br /> Information Technologies <br /> (Applicable only to hardwarelsofiware 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 Managcment <br /> This agreement is approved for suficienc • oidaUaibabd.ii�:standards,specifications,and requirements: <br /> Quso, (hrt"'t 6 7/2/2019 <br /> Office of the Risk Management Offices 7FDCF9176800498_ Date: <br /> Financial Services <br /> This instrument has been pre-audited ��i 1c°g br'qz uired by the Local Government Budget and Fiscal Control Act: <br /> ,� 4� 9/16/2019 <br /> Office of the Chief Financial Office _t'p4Fs,s,AC01409 Date: <br /> Legal Services <br /> This agreement is approved as tiHep&f1ourwand sufficiency: <br /> Office of the County Attorney <br /> '\ Date: 9/16/2019 <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 /> Contract-Genera! (06/19) Page 4 of 4 <br />