HomeMy WebLinkAboutR 2019-636 DSS - Charles House adult day care DocuSign Envelope ID: FBA030F0-9120-42B9-A272-5932D959B8F6 Contract#68-2042
Charles House
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone:919-967-7570 Party/Vendor
Address:7511 Sunrise Road City Chapel Hill State:NC Zip:27514 Department:Social Services Amount:$24,000 Purpose:adult day
care Budget Code(s): 10405020-764100& 10405020-764101 Vendor 9 19446 (N/A if new vendor) Vendor is a BOCC consultant?
Yes ❑No® Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date July 1,2019 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:
Noun c� rbS�b�t Date:7/9/2019
Department Director's Signature
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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 hardwarelsofiware 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 Managcment
This agreement is approved for suficienc • oidaUaibabd.ii�:standards,specifications,and requirements:
Quso, (hrt"'t 6 7/2/2019
Office of the Risk Management Offices 7FDCF9176800498_ Date:
Financial Services
This instrument has been pre-audited ��i 1c°g br'qz uired by the Local Government Budget and Fiscal Control Act:
,� 4� 9/16/2019
Office of the Chief Financial Office _t'p4Fs,s,AC01409 Date:
Legal Services
This agreement is approved as tiHep&f1ourwand sufficiency:
Office of the County Attorney
'\ Date: 9/16/2019
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:
Contract-Genera! (06/19) Page 4 of 4