R 2016-345-E Health - Empowerment, Inc. to provide Zone 6 Navigator services

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DocuSign Envelope ID: BOE6B23D-1629-4BF1-A924-7DE9EC51D728 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: $75.290 Purpose: Provide Zone 6 Navigator Services 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 7/1/16 Approved by Board Yes❑ No❑ Agenda Date: This agreement is approved as to tec R1°Fbbh11d id c ntent: j5v 7/6/2016 Department Director's Signature Date: Information Technolo0es (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 /ri uWacelstandards, specifications,and requirements: QUSA. r,Orv�,c,�16 7/6/2016 Office of the Risk Management Officer Date: AFDC—FiJ9 FoS90&95... Financial Services This instrument has been pre-audited i t e° M N%quired by the Local Government Budget and Fiscal Control Act: ('� 7/7/2016 Office of the Chief Financial Officer 7o4ES1a1ACC1409... Date: Legal Services This agreement is approved as t t�07�d sufficiency:Office of the County Attorney 7/8/2016 �',1 ,1 S(`RR�(ld(`Od OQ Date. Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecount.nic.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 6 of 6 Revised 512016