HomeMy WebLinkAboutR 2018-753 Finance - Haven House outside agency agreement(Haven House Inc.)
Orange County Cardinal Managed CareFund Performance AgreementPage 7of 9
Rev. 8/18
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Haven House Inc.Party/Vendor Contact Person: Michelle ZechmannContact Phone: 919-833-
3312Party/Vendor Address: 600 W Cabarrus StreetCity RaleighState: NCZip: 27603Department: Finance and
Administrative ServicesAmount: 19,000Purpose: Cardinal Innovations Managed Care Performance Agreement for
FY2018-19Budget Code(s): 10420020-710050Vendor # 801445(N/A if new vendor) Vendor is a BOCC
consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date
7/1/2018Approved by Board Yes No Agenda Date: 6/19/2018
This agreement is approved as to technical form and content:
Department Director’s Signature ________________________________________ 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 ChiefInformation Officer___________________________________ Date: ________
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer ____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney __________________________________________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:_________
DocuSign Envelope ID: 71967441-379B-4CA2-8D25-FE89D1466307