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DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: Mental Health America of the Triangle Party/Vendor Contact Person: Delores Bailey <br /> Contact Phone: 919-967-8779 Party/Vendor Address: 109 N. Graham Street, 4200 City Chapel Hill State: NC <br /> Zip: 27516 Department: Health Amount: $36,576 Purpose: Hire Zone Navigators for FSA Program Budget <br /> Code(s): 10412020-681000-71453 Vendor 4 39185 (N/A if new vendor) Vendor is a BOCC consultant? Yes <br /> ❑No X Contract Type: (Check one)New X Renewal❑ Amendment ❑ Effective Date 10/17/15 Approved by <br /> Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to to 8dfuf"hYid content: <br /> 10/14/2015 <br /> Department Director's Signature c9FnnnnFCSea45F_ Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficient Djja ,:standards,specifications,and requirements: <br /> ausa, (hm,&b 10/19/2015 <br /> Office of the Risk Management Office Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: 1�DocuSigned by: <br /> Office of the Chief Financial Officer Date: 10/19/2015 <br /> Legal Services <br /> This agreement is approved as t ft4-f@incMrd sufficiency: <br /> Office of the County Attorneys Date: 10/19/2015 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Family Alliance Success Zone Navigators Page 6 of 10 <br /> Rev. 8115 <br />