HomeMy WebLinkAboutR 2016-491-E DSS - Charles House Association for adult day care DocuSign Envelope ID: 51CB0066-1185-4FDA-AC7B-8ClF27F6013F Contract#68-2009
Charles House Association
ORANGE COUNTY—DEPARTMENT USE ONLY
Departmen
Party/Vendor Name: Charl,-s Hou��—Association Party/Vendor Contact Person: Laul_Klever Contact Phone: (919) )67-7570
Party/Vendor Address: 109_14iliCrestAssOciation City�jarrboro State:NC Zip:275 10 Department: Social—Services Aniount: $25�O00
Purpose:Adult_Day Care Budget Code(s): 10405020-764 100 Vendor# 19446 (N/A if new vendor) Vendor is a BOCC consultant?
Yes F-I NoE Contract Type:(Check one)-�ew_Ej Ren—ewal E Amendment [I Effective Date jqly I_20 16 Approved by Board Yes
E] NoZ Agenda Date:_
This agreement is approved as to technical form a. tp
,qj$qed by:
N" 66st6w 8/25/2016
Department Director's Signature tl -5�----Date:—
r&AE4E496Ae3B4
Information Technolo2ies
(Applicable only to hardwarelsoftware 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 Managemen
This ap
,reement is approved for sufficiency of insurance i&Wsnp"cifications,and requirements:
8/22/2016
Office of the Risk Management Officer—_.- Date,
Financial Services
This instrument has been pre-audited in the manner r 'Pe6b5ntlhoLocal Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date: 8/25/2016
kGC44G9__ .......-
Legal Services
This agreement is approved as to legal form and suffi �usigned by:
Date: 8/26/2016
Office of the County Attorney 9-'_
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion(aD Dgil()Id(.diorangecoLintvne.aoN,
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board
Contract-General (07/10) Page 5 of 5