HomeMy WebLinkAboutR 2018-439 Finance - Boys and Girls Club of Durham and Orange Counties outside agency agreementDocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA
ORANGE COUNTY — DEPARTMENT USE ONLY
Department
Party/Vendor Name: Boys & Girls Club of Durham & Orange Counties Party/Vendor Contact Person: Jerome
Levis y Contact Phone: 919 - 687 -4517 Party/Vendor Address: 808 East Pettigrew Street; PO BOX 446 City Durham
State: NC Zip: 27702 Department: Finance & Administrative Services Amount: 5000 Purpose: FY 2018 -19 Outside
Agency /Human Services Performance Agreeement Budget Code(s): 10695050- 719055 Vendor # 800171 (N /A if
new vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) New ® Renewal ❑
Amendment ❑ Effective Date 7/1/2018 Approved by Board Yes ®No❑ Agenda Date: 6/19/2018
This agreement is approved as to technical form DocuSigned by:
8/16/2018
Department Director's Signature Date:
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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
Risk Management
Date:
This agreement is approved for sufficiency of in DocuSigned by: ' - cifications, and requirements:
US& (,b�6 8/17/2018
Office of the Risk Management Officer 117FDCF9176-900498 Date:
Financial Services
This instrument has been pre- audited in the mann DocuSigned ay: 3overnment Budget and Fiscal Control Act:
8/16/2018
Office of the Chief Financial Officer 7DaE51a1ACC,40s... Date:
Legal Services
This agreement is approved as to legal form and DocuSigned by:
y
Office of the County �' �'� Date: 8/17/2018
` y 4035CB8304CA4M...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion @ sin erg sollgoran eg countync. og_v
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
(Boys & Girls Club of Durham & Orange Counties)
Orange County Outside Agency Performance Agreement Page 7 of 9
Rev. 7118