HomeMy WebLinkAboutR 2016-604-E Finance - Duke HomeCare & Hospice - Outside Agency Performance Agreement DocuSign Envelope ID:38357F45-OFD1-474F-992F-A2DODA42A3E2
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Duke HomeCare & Hospice Party/Vendor Contact Person: BelleStarr Browning Contact
Phone: 919-479-0318 Party/Vendor Address: 4321 Medical Park Drive, Suite 101 City Durham State: NC Zip:
27704 Department: Finance &Administrative Services Amount: 1000 Purpose: Outside Agencies Funding Budget
Code(s): 10495050-710026 Vendor# 50707 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑
Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 7/1/16 Approved by Board Yes
®No❑ Agenda Date: 6/21/16
This agreement is approved as to technical forma cAfeWP"by:
Department Director's Signature Date:
Information Technologies
(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 Management
This agreement is approved for sufficiency of insuran W &�,:pecifieations,and requirements:
Office of the Risk Management Officer FDeaea Date:
Financial Services
This instrument has been pre-audited in the manner rc l26"T Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer �,o ,onam Date:
Legal Services
This agreement is approved as to legal form and suf pjVsignea by:
Office of the County Attorney 44J4 4 Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd&orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
(Duke HomeCare&Hospice)
Orange County Outside Agency Performance Agreement
Rev. 8116