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DocuSign Envelope ID:23D77C78-12E7-4A83-8951-OC79FA06A2CD <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: EmPOWERment, Inc. Party/Vendor Contact Person: Delores Bailey Contact Phone: 919- <br /> 967-8779 Party/Vendor Address: 109 N. Graham St. #200 City Chapel Hill State: NC Zip: 27516 Department: <br /> Housing and Community Development Amount: NTE $8,600 Purpose: EHA Outreach Consulting Budget <br /> Code(s): 32470320-630000 Vendor# 800065 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No <br /> ® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 4/30/2021 Approved by <br /> 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 /> cuSigned by: <br /> Department Director's Signature �'"""'O� Date: 5/11/2021 <br /> Agreements for emergency servicesL_�6�WNYIM--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 insurance standards,specifications,and requirements: <br /> DocuSign�ed""by: <br /> ''ll� <br /> Office of the Risk Management Officer auSa rbvvti,e,llb Date: 5/11/2021 <br /> 7FDCF9176800498... <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 /> Office of the Chief Financial Officer I"N O"� Date: 5/12/2021 <br /> EM4E5181ACC1409 <br /> Legal Services <br /> This agreement is approved as to le '1 f�rm� d sufficiency: <br /> 5/13/2021 <br /> Office of the County Attorney abi.ln.t, Mart_ �SCb Date: <br /> 079A4D525COF4F8... <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 /> Revised 07/20 <br /> 9 <br />