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DocuSign Envelope ID:DB9A9EC4-B024-400B-A663-138801D5215E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Empowerment, lnc.Party/Vendor Contact Person: Sairta Nwachukwu Contact Phone: 919-967- <br /> 8779 Party/Vendor Address: 109 N. Graham Street #200 City Chapel Hill State: NC Zip: 27516 Department: <br /> Health Amount: $203,759.27 Purpose: Provide Zone 6 Navigator Services Budget Code(s): 10412020-630000- <br /> 71453Vendor#39185 (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 ftu Pffi d content: <br /> Vat 8/21/2017 <br /> Department Director's Signature 5145A7C 045f140F 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 4F5'll' aYstandards,specifications,and requirements: <br /> aMiS& CbV'Ib 8/21/2017 <br /> Office of the Risk Management Office 7FDCF9176800498... Date: <br /> Financial Services <br /> r6 <br /> This instrument has been pre-audited i Dfliffi11?squired by the Local Government Budget and Fiscal Control Act: <br /> ja7, A.446,. 8/21/2017 <br /> Office of the Chief Financial Officer 7 G�19,o�w, 0e Date: <br /> Legal Services <br /> Do u igned by: <br /> This agreement is approved as l��]]ga� or �aAn',d�.suf iciency: <br /> '" '1' '"'''"''`1' SG6 8/21/2017 <br /> Office of the County Attorney 079A4D525C0F4FB... 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 />