HomeMy WebLinkAboutR 2016-633-E Finance - EmPOWERment, Inc. - Outside Agency Performance Agreement DocuSign Envelope ID:4FOB7605-OOEB-4D90-837E-574BBBBD89EB
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: EmPOWERment, Inc. Party/Vendor Contact Person: Delores Bailey Contact Phone: 919967-
8779 Party/Vendor Address: 109 N. Graham Street, Suite 200 City Chapel Hill State: NC Zip: 27516 Department:
Finance &Administrative Services Amount: 25000 Purpose: Outside Agencies Funding Budget Code(s): 10495050-
789005 Vendor# 800065 (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 for WC0iurtV*:
Department Director's Signature Date:
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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 ins ur d�;specifications,and requirements:
a�iSa CbV1n,f✓N
Office of the Risk Management Officer Fee Date:
Financial Services
This instrument has been pre-audited in the manner egt4l Vd' t Local Government Budget and Fiscal Control Act:
16.
Office of the Chief Financial Officer
ffi Date:
Legal Services
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This agreement is approved as to legal form and suf Icle 'gnea by:
Office of the County Attorney L� 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:
(EmPOWERment,Inc.)
Orange County Outside Agency Per/ormance Agreement
Rev. 8116