HomeMy WebLinkAboutR 2015-287-E Aging - Charles House Association for respite services DocuSign Envelope ID: BF4D7555-FC71-4DF1-810C-FC302E35CC4B
ORANGE COUNTY—DEPARTMENT USE ONLY
Deuartment
Party/Vendor Name: Charles House Party/Vendor Contact Person: Paul Klever Contact Phone: Party/Vendor
Address: 109 Hillcrest Avenue City Carrboro State:NC Zip: 27510 Department: Aging Amount: $12,000 Purpose:
respite services Budget Code(s): 10432020-630105 Vendor 4 19446 (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 1,
2015 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to techni^ of9e content:
Department Director's Signature , AJJUU- Ty�-r Date: 6/24/2015
B7E962D1BF454FA...
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficiency of insurance standards,specifications,and requirements:
DocuSigned""by:''1L
Paustu r,6n tt0 6/25/2015
Office of the Risk Management OfficerDate:
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in t 13�g A TgRuired by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer PAUL, ['"-+6VU Date: 6/25/2015
232DFFC2CFA847B...
Legal Services
This agreement is approved as to le &fQM1gn4:sufficiency:
Office of the County Attorney 1� Date: 6/25/2015
4035CB8304CA4A9...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 10/14 4