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DocuSign Envelope ID:9A9666B2-47F7-4058-AOEC-EABA9ACAC53A <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: CBF of North Carolina Party/Vendor Contact Person: Jim Hylton Contact Phone: <br /> Party/Vendor Address: 2640 Reynolda Rd City Winston Salem State:NC Zip: 27106 Department: Aging <br /> Amount: $13,000 Purpose: MAP Mandarin outreach Budget Code(s): 10430020-630120 Vendor#65172 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal <br /> Amendment ❑ Effective Date 7/1/2019 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 /> �aan.t�c - +b_ 10/15/2019 <br /> Department Director's Signature g7E9626IBF454FA.. Date' <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 sufficiency r Wcusigned by: ' Is,specifications,and requirements: <br /> aura. cbm_t,{�6 10/28/2019 <br /> Office of the Risk Management Officer_ Date: <br /> 7F�CF317E800498. <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 /> A 10/28/2019 <br /> Office of the Chief Financial Officer �oaES�s1ACCiao9. Date: <br /> Legal Services <br /> This agreement is approved as to- oocuSigned by: icy: <br /> Office of the County Attorney_ ��35Cg8� 304CA4A�CA4 Date: 10/28/2019 <br /> 4 <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 />