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XIL Agreement <br />I have read the aforementioned Agency Agreement and waiver for use of technology orthe LAJOC HMIS, <br />Equipment and Services (ifapplieable), and thoroughly understand that this technology is for LA/OC <br />HMIS purposes only. <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 />F,xecuuve Director's Narne (Print) <br />it <br />Executive Directors Signature <br />Agency Name <br />Date of Signature <br />Contigpum Representative's Na a (Pont) <br />Continuum Representative's Signattfrree1 <br />Continuum Name V <br />_JJL�L -7 2 <br />Date of Signature <br />HMIS:fgencyAgreement Page 5of5 Revr4ed02101108 <br />