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(Haven House Inc.) <br />Orange County Cardinal Managed CareFund Performance AgreementPage 7of 9 <br />Rev. 8/18 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Haven House Inc.Party/Vendor Contact Person: Michelle ZechmannContact Phone: 919-833- <br />3312Party/Vendor Address: 600 W Cabarrus StreetCity RaleighState: NCZip: 27603Department: Finance and <br />Administrative ServicesAmount: 19,000Purpose: Cardinal Innovations Managed Care Performance Agreement for <br />FY2018-19Budget Code(s): 10420020-710050Vendor # 801445(N/A if new vendor) Vendor is a BOCC <br />consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date <br />7/1/2018Approved by Board Yes No Agenda Date: 6/19/2018 <br />This agreement is approved as to technical form and content: <br />Department Director’s Signature ________________________________________ 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 ChiefInformation Officer___________________________________ Date: ________ <br />Risk Management <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />Office of the Risk Management Officer___________________________________ Date: _________ <br />Financial Services <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________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 />DocuSign Envelope ID: 71967441-379B-4CA2-8D25-FE89D1466307 <br /> <br /> <br /> <br />