HomeMy WebLinkAboutR 2015-554-E Health - Empowerment, Inc. to hire zone navigators for FSA program DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D
ORANGE COUNTY—DEPARTMENT USE ONLY
Deuartment
Party/Vendor Name: Mental Health America of the Triangle Party/Vendor Contact Person: Delores Bailey
Contact Phone: 919-967-8779 Party/Vendor Address: 109 N. Graham Street, 4200 City Chapel Hill State: NC
Zip: 27516 Department: Health Amount: $36,576 Purpose: Hire Zone Navigators for FSA Program Budget
Code(s): 10412020-681000-71453 Vendor 4 39185 (N/A if new vendor) Vendor is a BOCC consultant? Yes
❑No X Contract Type: (Check one)New X Renewal❑ Amendment ❑ Effective Date 10/17/15 Approved by
Board Yes❑No❑ Agenda Date:
This agreement is approved as to to 8dfuf"hYid content:
10/14/2015
Department Director's Signature c9FnnnnFCSea45F_ Date:
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 Djja ,:standards,specifications,and requirements:
ausa, (hm,&b 10/19/2015
Office of the Risk Management Office Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: 1�DocuSigned by:
Office of the Chief Financial Officer Date: 10/19/2015
Legal Services
This agreement is approved as t ft4-f@incMrd sufficiency:
Office of the County Attorneys Date: 10/19/2015
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
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