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XII. Agreement <br />I have read the aforementioned Agency Agreement and waiver for use of technology of the LA/OC HMIS, <br />Equipment and Services (if applicable), and thoroughly understand that this technology is for LA/OC <br />HMIS purposes only. <br />Agency Name <br />This Agreement is executed between the Agency and the Orange County Continuum of Care and upon <br />execution the Agency will be given access to the HMIS. This agreement will be signed by the Executive <br />Director at the Participating Agency. <br />Executive irector' me (Print) <br />Executive Director's( ignature <br />4?'Lty\. <br />k)UV1e 17, ooq <br />Date of Signature <br />Contin um Representative s ame (Print) <br />Continuum Representative's Si ture <br />0 na rXAP C4&fAk 0 V,? <br />Continuur Name <br />Date' bf Signature <br />HMIS Agency Agreement Page 5 of 5 Revised 02101/08