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DocuSign Envelope ID:8E87460E-053E-4F51-836A-0798AA5D163E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Freedom HouseParty/Vendor Contact Person: Patricia Hussey Contact Phone: 919-942-8083 <br /> Party/Vendor Address: 104 New Stateside Drive City Chapel Hill State: NC Zip: 27516 Department: Health <br /> Amount: $156,415.69 Purpose: Provide Zone 4 Navigator Services Budget Code(s): 10412020-630000- <br /> 71453Vendor#34104 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No ® Contract Type: (Check <br /> one) New ❑ Renewal X Amendment ❑ Effective Date 7/1/17 Approved by Board Yes No Agenda <br /> Date: <br /> This agreement is approved as to to , .d content: <br /> 7/10/2017 <br /> Department Director's Signature L6ttU1 <br /> 5145A2CD945C40F... 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 sufficienc EN 4fs'iiOariaYsstaandards, specifications,and requirements: <br /> LtSA rbvvutl6 7/11/2017 <br /> Office of the Risk Management Officer 7FDCF9176800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited i eDifffiffitiuft quired by the Local Government Budget and Fiscal Control Act: <br /> (" <br /> An °'Z 0 7/11/2017 <br /> Office of the Chief Financial Officer D4ES,aIACCian9 Date: <br /> Legal Services <br /> This agreement is approved as t e cTVP 14 lii1_sufficiency: <br /> 1' Aunt, SCb <br /> 7/11/2017 <br /> Office of the County Attorney 07g44.0 ,5COF4FR 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 /> Page 7 of 6 <br /> Revised 5/2016 <br />