HomeMy WebLinkAboutR 2015-524-E Health - Mental Health America of the Triangle DocuSign Envelope ID:24392949-6CFE-4A47-8FC6-54FF2C794193
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Mental Health America of the Triangle Party/Vendor Contact Person: Marci White Contact
Phone: 919-942-8083 Party/Vendor Address:PO Box 16246 City Chapel Hill State:NC Zip: 27516 Department:
Health Amount: $38,817 Purpose: Hire Zone Navigators for FSA Program Budget Code(s): 10412020-681000-
71453 Vendor 4 41515 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No X Contract Type:
(Check one) New X Renewal ❑ Amendment ❑ Effective Date 9/19/15 Approved by Board Yes❑ No❑
Agenda Date:
This agreement is approved as to to t°8 bvi Q 'Md c�oAnteent:
Department Director's Signature �Q�FC�s�a�E Date: 9/21/2015
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 da sax% eys''tandards,specifications,and requirements:
aura, r,6vvt,e b 9/21/2015
Office of the Risk Management Officer Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSignn �e�d�bby::
Office of the Chief Financial Officer ' DFFE�EFA84�B... Date: 9/21/2015
Legal Services
This agreement is approved as t ft4"i"daWd sufficiency:
Office of the County Attorneys Date: 9/23/2015
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Family Alliance Success Zone Navigators Page 6 of 10
Rev. 8115