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DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Refugee Support Center Party/Vendor Contact Person: Flicka Bateman Contact Phone: 919- <br /> 423-1478 Party/Vendor Address:401 NC 54 Byp,E#15 City:Carrboro State:NC Zip:27510 Department:Human <br /> Rights&Relations Amount: 5,000 Purpose: Provide a centralized location of services for refugees Budget Code(s): <br /> Vendor#62967 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check <br /> one)New ❑ Renewal❑ Amendment ❑ Effective Date Approved by Board Yes❑ No❑ Agenda <br /> Date: <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 /> DocuSigned by: <br /> Eimti 4/22/2021 <br /> Department Director's Signature aossceasoacaaA9... 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 of insur Awdeode;specifications, and requirements: <br /> aura. Chnu,TTb 4/25/2021 <br /> Office of the Risk Management Officer Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner r un$gf`h3�°`�f ILocal Government Budget and Fiscal Control Act: <br /> ('1� +� 4/26/2021 <br /> Office of the Chief Financial Officer 1Acc14o9 . Date: <br /> Legal Services <br /> This agreement is approved as to legal form and suf ciency igned by: <br /> alnk , ,V�U'll, 'No 4/26/2021 <br /> Office of the County Attorney o�saaoszecoFaFe... Date: <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 /> Orange County Outside Agency Performance Agreement Page 6 of 9 <br /> Rev. 1121 <br />