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DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C78lB247516E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name:EmPOWERment,Inc Party/Vendor Contact Person:Delores Bailey Contact Phone:919-967-8779 <br /> Party/Vendor Address: 109 N. Graham Street #200 City Chapel Hill State: NC Zip: 27516 Department: Finance & <br /> Administrative Services Amount: $50,000 Purpose: FY 2020-21 Outside Agency/Human Services Performance <br /> Agreement Budget Code(s): 10495050-710015 Vendor#800065 (N/A if new vendor)Vendor is a BOCC consultant? <br /> Yes❑No® Contract Type: (Check one)New®Renewal❑Amendment❑Effective Date 7/l/2020 Approved by <br /> Board Yes®No❑Agenda Date: 6/16/2020 <br /> This agreement is approved as to technical sforrr�and content: <br /> ocu ort 'a <br /> Department Director's SignatureEAD42BO75CF42M7 <br /> WA Sl bin. Date: 1/27/2021 <br /> ... <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 of insurance standards,specifications,and requirements: <br /> DocuSigned""by: <br /> ''ll� <br /> Office of the Risk Management OfficerPCs& rbvvu 6 Date:112712021 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in th%maocu�egr�y quired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer e� Date: 1/27/2021 <br /> 7NE5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ocuSigned by: <br /> Office of the County Attorne 04CMA Date: 1/27/2021 <br /> 4035CB839... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion @ sin erg sollP_oran eg countync. oovv <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 /> EmPOWERment,Inc <br /> Orange County Outside Agency Performance Agreement Page 6 of 9 <br /> Rev. 1121 <br />