HomeMy WebLinkAboutR 2017-430-E Health - Boomerang Youth, Inc. - Outside Agency Performance Agreement DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Boomerang Youth, Inc. Party/Vendor Contact Person: Sonia Frischemeier Contact Phone:
919-968-2146 Party/Vendor Address: 825A N. Estes Drive City Chapel Hill State: NC Zip: 27514 Department:
Finance & Administrative Services Amount: 11725 Purpose: FY 2017-18 Outside Agency Performance Agreement
Budget Code(s): 10495050719047 Vendor# 800750 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑
No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7/1/2017 Approved by
Board YesZ No Agenda Date: 6/20/2017
This agreement is approved as to technical forr oocuSigned by:
8/31/2017
Department Director's Signature 7D4E5181 ACC 14n 9 Date:
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 insure USA by: [cations,and requirements:
a (SO Co 6 8/31/2017
Office of the Risk Management Officer 7FDCF917E800498... Date:
Financial Services
DocuSilned by:
This instrument has been pre-audited in the mann iovernment Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date: 8/31/2017
7D4E5 181 ACC 14n9...
Legal Services
This agreement is approved as to legal form and °a`usigned by:
glAlo.tt, i' l hhCb 8/31/2017
Office of the County Attorney - 079A4D525COF4FB... Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ )rl oyd @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:
(Boomerang Youth,Inc.)
Orange County Outside Agency Performance Agreement Page 7 of 10
Rev. 7/17