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DocuSign Envelope ID:0E7E482D-4CE0-48F9-B5CE-2A694A0C6D9C <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Empowerment, Inc. Party/Vendor Contact Person: Sairta Nwachukwu Contact Phone: 919-967-8779 <br /> Party/Vendor Address: 109 N. Graham Street#200 City Chapel Hill State: NC Zip: 27516 Department: HEALTH Amount: <br /> $14,551 Purpose: Navigator Agreement Amendment contract#2016-345 Budget Code(s): 10412020-681000-71453 Vendor <br /> #39185 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New ❑ Renewal <br /> ❑ Amendment ® Effective Date 1/1/17 Approved by Board Yes No Agenda Date: <br /> D e Si ned <br /> This agreement is approved as to to nhc a b :d,c nt: <br /> (('�d 2/23/2017 <br /> Department Director's Signature C9ED9DOFC6B545E... Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to <br /> information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency • :kg/tYttvM.andards,specifications, and requirements: <br /> aLtSa C,Ovvt.c,ltb 2/23/2017 <br /> Office of the Risk Management Officer ___7FDCF9176800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited i e 4-ffilligndriElquired by the Local Government Budget and Fiscal Control Act: <br /> el a9tiy ArLitiiaosL 3/7/2017 <br /> Office of the Chief Financial Officer 7D4F5181ACC140A Date: <br /> Legal Services <br /> This agreement is approved as t eg�Pfbti'i�aiYd sufficiency: <br /> -� k 3/14/2017 <br /> Office of the County Attorney aoqcceR�oacoa,a Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.gov <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 /> Revised July 2015 <br />