HomeMy WebLinkAboutR 2019-448 Aging - Charles House Association adult day care DocuSign Envelope ID: DBE71181-5A2C-4DC5-B867-8C8C1FCB2DCF
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Charles House Association Party/Vendor Contact Person: Contact Phone:
Party/Vendor Address: 7511 Sunrise Road City Chapel Hill State: NC Zip: 27514 Department: Aging Amount:
8000.00 Purpose: Adult Daycare services Budget Code(s): 10432020-630100 and 630105 Vendor# 19446 (N/A
if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal
Amendment ❑ Effective Date Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work
on this project has not been initiated prior to execution of the agreement:
Docusigned by:
Department Director's Signature D.
Date: 7/10/2019
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Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that
was addressed:
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 sufficient rD'ocusigned by:" ' rds,specifications,and requirements:
Office of the Risk Management OfficerlUSa CbVln.tAb Date: 7/10/2019
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Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: Docusigned by:
41 .e.4ra. 7/10/2019
Office of the Chief Financial Officer Date:
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Legal Services
This agreement is approved as to lega' " Docusigned by:
Office of the County Attorney •�°'"' - Date: 7/11/2019
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Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@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 12/18
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