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DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: National Association of State Mental Health Program Directors Research Institute, Inc. <br /> Party/Vendor Contact Person: Tim Knettler Contact Phone: 703-738-8160 Party/Vendor Address: 3141 Fairview <br /> Park Drive, Suite 650 City Fall Church State: VA Zip: 22042 Department: Health Amount: $78,769 Purpose: <br /> Conduct behavioral health system of care analysis. Budget Code(s): 10414020-630000 Vendor#N/A (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 11-15-17 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to to DocuSigned by: nt: <br /> ,6rb{� 6W 11/15/2017 <br /> Department Director's Signature 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 -oocuSlgned by: rds, specifications,and requirements: <br /> Qusa, (��6 11/15/2017 <br /> Office of the Risk Management Officer 7FDCF9176900498... 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: DocuSigned by: <br /> Office of the Chief Financial Office 7NE5181ACC1469. Date: 11/20/2017 <br /> .. <br /> Legal Services <br /> This agreement is approved as t OocuSigned by: {� <br /> 9KIAk t, { 11/20/2017 <br /> Office of the County Attorney 079A4D525COF4F6... Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd&oran eg countync. og_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 /> Revised 2/17 9 <br />