HomeMy WebLinkAboutR 2017-078-E DSS - The Exchange Club's Familv Center in Alamance - Outside Agency Performance Agreement 1
DocuSign Envelope ID:AB039DC1-8309-4D41-B525-6E84F973FAA6
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: The Exchange Club's Family Center in Alamance Party/Vendor Contact Person: George
Bryan Contact Phone: 336-748-9028 Party/Vendor Address: 200 N. Main Street City: Graham State: NC Zip:
27253 Department: Social Services Amount: $6,175 Purpose: Outside Agency Performance Agreement Budget
Code(s): 10400120-630000 Vendor 62677 (N/A if new vendor) Vendor is a BOCC consultant? Yes No X
Contract Type: (Check one)New Lii Renewal E Amendment E Effective Date July 1, 2016 Approved by Board
Yes X NoE] Agenda Date: June 16, 2016
This agreement is approved as to technical form and irisigned by:
NUAttl £4StOtA, 2/10/2017
Department Director's Signature Date:
BAH El-96 A13313455
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 insuranc .14EiefrigaVvcifications,and requirements:
tiSO CartAki-to
2/1/2017
Office of the Risk Management Officer__ Date:
7 FD6R,9-1-76812■0498
Financial Services
This instrument has been pre-audited in the manner re ireB0br€EVI!),25Cal Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date: 2/10/2017
7 D4E5184ACC1401:4
Legal Services
This agreement is approved as to legal form and suff ket!Signed by:
Office of the County Attorney 40.4._
ate: 2/15/2017
4035C00304CA4A9- D
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Polloyckik)samecountynccov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
rrhe`E.xchange Cluk's I anvly Ce?Yer i?"1410M )
Orange County Outside Agency Performance Agreement
Rev. 8/16