HomeMy WebLinkAboutR 2016-137-E Health - Mental Health America of the Triangle - Amendment to navigator agreement DocuSign Envelope ID:7190449A-3B32-4622-B7F4-C359EAAB94BA
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: 4.800 Purpose: Navigator Agreement Amendment Budget Code(s): 10412020-681000-71453 Vendor # 63372
(N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ❑
Amendment ® Effective Date 1/1/16 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to to /c°8PM �d c ntent:
l�Z �� 2/2/2016
Department Director's Signature ee�s�a�a�€... Date:
Information Technolosies
(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 sufficiency i ane standards, specifications,and requirements:
QUSA. r,Orv�,c,r16 2/2/2016
Office of the Risk Management Officer 9,�,9„0A� Date:
Financial Services
This instrument has been pre-audited in e Y1sM1 YRjuired by the Local Government Budget and Fiscal Control Act:
ta
Office of the Chief Financial Officer Li 7D4E5181ACC1409... Date: 2/2/2016
Legal Services
This agreement is approved as t eAWlCf." . sufficiency:
-��-��� 2/3/2016
Office of the County Attorney a� S ,RR,�a�,odo, Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecount.nic.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised July 2015