2021-036-E Social Svc-Main Street Clinical Associates client services

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DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: Main Street Clinical Associates, PA Party/Vendor Contact Person: Katy Harper Contact Phone: 919-286-3453 Party/Vendor Address: 3326 Durham-Chapel Hill Blvd.,Building C-Suite 320 City Durham State: NC Zip: 27707 Department: Social Services Amount: $6,000 Purpose: psychological evaluations/court testimony Budget Code(s): 10400220-761005/10405020-768000 Vendor# 16258 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7/1/2020 Approved by Board Yes❑No❑ Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: D cbSfbin. Date:ocuSigned by: Department Director's Signature 1/22/2021 NOUit.G� Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficient �aasN�a y:standards,specifications,and requirements: Office of the Risk Management Office it � Date: 1 21 2021 Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: 7' Office of the Chief Financial Officer (� 0osa..lti Date: 1/26/2021 Legal Services This agreement is approved as ty4egaicftxmd=d sufficiency: Office of the County Attorney �' Date:1/26/2021 Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 07/20 9