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(«Agencys_Name») <br />Orange County Outside Agency Performance Agreement Page 6 of 9 <br />Rev. 7/18 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Senior care of Orange County Name: Party/Vendor Contact Person Contact Phone: 919-245-2017 <br />Party/Vendor Address: 105 Meadowland Drive City ; Hillsborough State: NC Zip: 27278 Department: Finance & <br />Administrative Services Amount:$36,500 Purpose: FY 2020-21 Outside Agency/Human Services Performance <br />Agreeement Budget Code(s): 10495050-719027 Vendor # 800047 Vendor is a BOCC consultant? Yes No <br />Contract Type: (Check one) New Renewal x Amendment Effective Date 7/1/2020 Approved by Board Yes <br /> No Agenda Date: <br /> <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <br /> <br />Information Technologies <br /> <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 /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersoll upon completion @ singersoll@orangecountync.gov <br /> <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br /> <br /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />DocuSign Envelope ID: 4A1A8EC9-D4E0-4A05-A302-572F4C69566D <br />5/25/2021 <br />5/27/2021 <br />5/27/2021 <br />5/27/2021