R 2015-524-E Health - Mental Health America of the Triangle

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DocuSign Envelope ID:24392949-6CFE-4A47-8FC6-54FF2C794193 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: $38,817 Purpose: Hire Zone Navigators for FSA Program Budget Code(s): 10412020-681000- 71453 Vendor 4 41515 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No X Contract Type: (Check one) New X Renewal ❑ Amendment ❑ Effective Date 9/19/15 Approved by Board Yes❑ No❑ Agenda Date: This agreement is approved as to to t°8 bvi Q 'Md c�oAnteent: Department Director's Signature �Q�FC�s�a�E Date: 9/21/2015 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 sufficient da sax% eys''tandards,specifications,and requirements: aura, r,6vvt,e b 9/21/2015 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: DocuSignn �e�d�bby:: Office of the Chief Financial Officer ' DFFE�EFA84�B... Date: 9/21/2015 Legal Services This agreement is approved as t ft4"i"daWd sufficiency: Office of the County Attorneys Date: 9/23/2015 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Family Alliance Success Zone Navigators Page 6 of 10 Rev. 8115