Orange County NC Website
Browse       Search
DocuSign Envelope ID: D76EOBB3-1E71-4C6C-B396-A64E9777B70E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Haven House Inc. DBA Haven House Services Party/Vendor Contact Person: Michelle <br /> Zechmann Contact Phone: 919-833-3312 Party/Vendor Address: 600 West Cabarrus Street City Ralei State: NC <br /> Zip: 27603 Department: Social Services Amount: $19,000 Purpose: Cardinal Innovations MOE Budget Code(s): <br /> 10420020-710050 Vendor#801445 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract <br /> Type: (Check one)New ❑ Renewal® Amendment ❑ Effective Date 7/l/2020 Approved by Board Yes®No <br /> ❑ Agenda Date: 6/16/2020 <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initiated prior to execution of the agreement: <br /> ocuSigned by: <br /> Department Director's Signature[;_.,,,,1 C,bSfbin. Date:1/19/2021 <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 sufficienc � rgiag(Bystandards, specifications, and requirements: <br /> / / <br /> 2021 <br /> Office of the Risk Management Officer QUSa vvullb 1 Date: 19 <br /> Financial Services <br /> This instrument has been pre-audited' f 4vquired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: 1/21/2021 <br /> Legal Services <br /> This agreement is approved as t €14 ",Wd sufficiency: <br /> Office of the County Attorney '\ Date:1/25/2021 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@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 /> («Agencys Name» <br /> Orange County Cardinal Managed Care Fund Performance Agreement Page 7 of 9 <br /> Rev. 112021 <br />