HomeMy WebLinkAboutR 2017-411-E Aging - Charles House Association for adult day care services DocuSign Envelope ID:AF4EB7D3-2ECB-4572-BEB5-A7B57F5BAA00
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone:
Party/Vendor Address: 7511 Sunrise Rd City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: $6,600
Purpose: adult day care services Budget Code(s): 10432020-630100 Vendor# 19446 (N/A if new vendor) Vendor
is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective
Date 8/20/17 Approved by Board Yes No Agenda Date:
This agreement is approved as to technical form and content:
/^--DocuSigned by:
Department Director's Signature i .tGt- � t V Date:
8/24/2017
B7E962D1BF454FA...
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:
r---DocuSigned by:
aLtS& Cb b 8/25/2017
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 Date: 8/25/2017
—7D4E5181 ACC1409...
Legal Services
This agreement is approved as to legal form and sufficiency:
p--DocuSigned by:
County Attorney al�UA.t, hark, fibSGb 8/25/2017
Office of the Coun Attorne Date:
`—079A4D525C0F4FB...
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:
Revised 2/17 5