HomeMy WebLinkAboutR 2016-345-E Health - Empowerment, Inc. to provide Zone 6 Navigator services DocuSign Envelope ID: BOE6B23D-1629-4BF1-A924-7DE9EC51D728
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Empowerment, Inc. Party/Vendor Contact Person: Sairta Nwachukwu Contact Phone: 919-
967-8779 Party/Vendor Address: 109 N. Graham Street#200 City Chapel Hill State: NC Zip: 27516 Department:
Health Amount: $75.290 Purpose: Provide Zone 6 Navigator Services Budget Code(s): 10412020-681000-71453
Vendor#39185 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)
New❑ Renewal ® Amendment ❑ Effective Date 7/1/16 Approved by Board Yes❑ No❑ Agenda Date:
This agreement is approved as to tec R1°Fbbh11d id c ntent:
j5v 7/6/2016
Department Director's Signature Date:
Information Technolo0es
(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 /ri uWacelstandards, specifications,and requirements:
QUSA. r,Orv�,c,�16 7/6/2016
Office of the Risk Management Officer Date:
AFDC—FiJ9 FoS90&95...
Financial Services
This instrument has been pre-audited i t e° M N%quired by the Local Government Budget and Fiscal Control Act:
('� 7/7/2016
Office of the Chief Financial Officer 7o4ES1a1ACC1409... Date:
Legal Services
This agreement is approved as t t�07�d sufficiency:Office of the County Attorney 7/8/2016
�',1 ,1 S(`RR�(ld(`Od OQ 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:
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Revised 512016