HomeMy WebLinkAboutR 2017-108-E Health - Empowerment, Inc. - Navigator Agreement Amendment to 2016-345-E DocuSign Envelope ID:0E7E482D-4CE0-48F9-B5CE-2A694A0C6D9C
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:
$14,551 Purpose: Navigator Agreement Amendment contract#2016-345 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 1/1/17 Approved by Board Yes No Agenda Date:
D e Si ned
This agreement is approved as to to nhc a b :d,c nt:
(('�d 2/23/2017
Department Director's Signature C9ED9DOFC6B545E... 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 sufficiency • :kg/tYttvM.andards,specifications, and requirements:
aLtSa C,Ovvt.c,ltb 2/23/2017
Office of the Risk Management Officer ___7FDCF9176800498... Date:
Financial Services
This instrument has been pre-audited i e 4-ffilligndriElquired by the Local Government Budget and Fiscal Control Act:
el a9tiy ArLitiiaosL 3/7/2017
Office of the Chief Financial Officer 7D4F5181ACC140A Date:
Legal Services
This agreement is approved as t eg�Pfbti'i�aiYd sufficiency:
-� k 3/14/2017
Office of the County Attorney aoqcceR�oacoa,a Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.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