HomeMy WebLinkAboutR 2017-402-E Health - Empowerment, Inc. - Outside Agency Performance Agreement DocuSign Envelope ID:DB9A9EC4-B024-400B-A663-138801D5215E
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Empowerment, lnc.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: $203,759.27 Purpose: Provide Zone 6 Navigator Services Budget Code(s): 10412020-630000-
71453Vendor#39185 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No ® Contract Type: (Check
one) New ❑ Renewal X Amendment ❑ Effective Date 7/1/17 Approved by Board Yes No Agenda
Date:
This agreement is approved as to to ftu Pffi d content:
Vat 8/21/2017
Department Director's Signature 5145A7C 045f140F 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 sufficienc 4F5'll' aYstandards,specifications,and requirements:
aMiS& CbV'Ib 8/21/2017
Office of the Risk Management Office 7FDCF9176800498... Date:
Financial Services
r6
This instrument has been pre-audited i Dfliffi11?squired by the Local Government Budget and Fiscal Control Act:
ja7, A.446,. 8/21/2017
Office of the Chief Financial Officer 7 G�19,o�w, 0e Date:
Legal Services
Do u igned by:
This agreement is approved as l��]]ga� or �aAn',d�.suf iciency:
'" '1' '"'''"''`1' SG6 8/21/2017
Office of the County Attorney 079A4D525C0F4FB... 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:
Page 7 of 6
Revised 5/2016