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DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: The Arc of the Triangle,Inc. Party/Vendor Contact Person: Jennifer Pfaltzgraff Contact Phone: <br /> 919-942-5119 Party/Vendor Address: 1709 Legion Road, Suite 100 City Chapel Hill State: NC Zip: 27517 <br /> Department: Social Services Amount: $39,973 Purpose: outside agency funds +Behavioral Health MOE Budget <br /> Code(s): 10420020-710050/10495050-719023 Vendor#50706 (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 <br /> by Board Yes®No❑ Agenda Date: 6/16/2020 <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initiated prior to execution of the agreement: <br /> pDooccuSiggneddby* <br /> Department Director's Signature N- -1 (,hs bt& Date:2/10/2021 <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 sufficien foMiW1 :standards,specifications,and requirements: <br /> QuSa CbV'In,h{fb 1/26/2021 <br /> Office of the Risk Management Office �eaeoa� Date: <br /> Financial Services <br /> This instrument has been pre-audited' mnerasequired by the Local Government Budget and Fiscal Control Act: <br /> rqta +� � <br /> Office of the Chief Financial Officer Date: 2/11/2021 <br /> Legal Services <br /> This agreement is approved as t gl!4@ti -&%d sufficiency: <br /> Office of the County Attorney ` Date:2/11/2021 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@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 /> (aAgencys Na me <br /> Orange County Outside Agency Performance Agreement Page 8 <br /> Rev. 112021 <br />