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Contract#68-2074 <br /> Charles House <br /> <br />Contract-General (06/19) Page 5 of 5 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone: 919-967-7570 <br />Party/Vendor Address: 7511 Sunrise Road City Chapel Hill State: NC Zip: 27514 Department: Social Services/Aging <br />Amount: $48,000 Purpose: adult day care Budget Code(s): 10405020-764100/10405020-764101/10432020- <br />630100/10432020-630105 Vendor # 19446 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract <br />Type: (Check one) New Renewal Amendment Effective Date July 1, 2022 Approved by Board Yes No <br />Agenda Date: <br /> <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not <br />been initiated prior to execution of the agreement: <br /> <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br />Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have <br />already begun or been completed please briefly describe the nature of the emergency condition that was addressed: <br /> <br />Information Technologies <br /> <br />(Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is approved as to <br />information technology content and specifications: <br /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <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 />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 />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 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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br />DocuSign Envelope ID: 2BDD55A6-AB10-4CEE-BD64-A15242793F1F <br />8/9/2022 <br />8/10/2022 <br />8/10/2022 <br />8/11/2022 <br />8/11/2022