HomeMy WebLinkAboutR 2015-320-E DSS - Charles House Association to provide adult day services to OC DSS clients DocuSign Envelope ID:27BE0809-07F1-4358-A397-lF35DD236252
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone: (91
967-7570 Party/Vendor Address: 109 Hillcrest Ave City Carboro State: NC Zip: 27510 Department: DSS
Amount: $25,000 Purpose: Provide Adult Day Services„to clients of Orange County DSS Budget Code(s):
10405020-764100 Vendor# 19446 (NIA if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract
Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 07/01/15 Approved by Board Yes®
No❑ Agenda Date:
This agreement is approved as to technical form Ettgited by:
NAArt G� �,OSf01�
Department Director's Signature Date: 6/30/2015
Information Technologies
(4pplicahle 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 ,} g§lbhp' 6 eecfcications, and requirements:
Office of the Risk Management Officer PUS& 66Vlit Date: 6/30/2015
WNUT-
Financial Services
This instrument has been pre-audited in the manner required by the Local. Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer PMA �'""D"" bin, Date: 7/7/2015
Legal Services
This agreement is approved as to legal form and eiyg by:
Office of the County Attorney - �l � Date: 7/7/2015
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dollo rdnoran ecount ,nc. ov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date: