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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name : NC Community Care Networks , Inc . Party/Vendor Contact Person : Cherie Ross Contact <br /> Phone : 919 -745 -2388 Party/Vendor Address : 2300 Rexwoods Drive , Suite 390 City Ralei h State : NC Zip : <br /> 27607 Department : Health Amount : $ 315 , 020 Purpose : PCCM Participation Budget Code (s) : 10414005443110 - <br /> 71402 /71412 Vendor # (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No ® Contract <br /> Type : (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7 - 149 Approved by Board Yes [:] No <br /> ❑ Agenda Date : <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement : <br /> Department Director ' s Signature v Date : 3 - <br /> Agreements for emergency services or repair are not subject to the above affirmation . If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed : <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 sufficiency of insurance standards , specifications , and requirements : <br /> ' r <br /> Office of the Risk Management Officer Date : ► i i <br /> Financial Services <br /> i <br /> This instrument has been pre- audited in the 114 er equ ' ed by the Local Government Budget and Fiscal Control <br /> Act : <br /> Office of the Chief Financial Officer Date : f <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency . <br /> Office of the County Attorney j�1it Date : 06 / 16 / 1 `I <br /> Clerk to the Board <br /> Received for record retention : <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion : singersoll@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 12/ 18 <br />