HomeMy WebLinkAboutR 2015-540-E Finance - EmPOWERment, Inc. - 2015-16 Outside Agency Performance Agreement DocuSign Envelope ID: 7055CF95-11 1 F-4521-91 ED-AAC3F4F34D28
ORANGE COUNTY—DEPARTMENT USE ONLY
Deuartment
Party/Vendor Name: EmPOWERment, Inc. Party/Vendor Contact Person: Delores Bailey Contact Phone: 919967-
8779 Party/Vendor Address: 109 N. Graham Street 4200 City Chapel Hill State: NC Zip: 27516 Department:
Finance & Adm. Srv. Amount:$ 20,000 Purpose: Outside Agency Performance Agreement Budget Code(s):
10495050 789005 Vendor 4 800065 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ NoX Contract
Type: (Check one)New ❑ Renewal ❑ Amendment ❑ Effective Date July 1,2015 Approved by Board YesX
No❑ Agenda Date: June 16,2015
This agreement is approved as to technic form bpd content:
ocuSigned by:
Department Director's Signature
�q blti Date: 10/2/2015
232DFFC2CFA847B...
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
Q�As& r,6vvt,e b 10/1/2015
Office of the Risk Management Officer Date:
7FDCF9176800498...
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
bVu Date: 10/2/2015
232DFFC2CFA847B...
Legal Services
This agreement is approved as to le a�fo n daufficiency:
Office of the County Attorney I ✓A Date: 10/5/2015
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:
(EmPOWERment,Inc)
Orange County Outside Agency Performance Agreement Page 6 of 7
Rev. 6115