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XIL Agreement <br />I have read the aforementioned Agency Agreenutit and waiver for use of technology of the LA /OC HM IS, <br />Equipment and Services (>fapplicable), and thoroughly understand that this technology is for LAIOC <br />IEv115 purposes only. <br />This Agreement is executed between the Agency and the <br />Orange County Continuum of Care and upon <br />execution the Agency will be given access to the HMIS. <br />')'his agreemau will be signed by the Executive <br />Director at the Participating Agency. <br />Ex c tive Direcmr'sName (Print) <br />Continuuu Representative "s ante (Print) <br />r �xccutfvifbireclurs Signature <br />Continuum Representative's Sf6rulture <br />ME.tZO -11 � 1� <br />6 f d Yl C <br />Agency Na e <br />Conthtutnn NNa e <br />'O in <br />t t n <br />Date fSi nature <br />— <br />Date fSignauue <br />ID 11S Agemv e An"aement Page 5 of 5 Revised 02"01/08 <br />