2020-890-E Social Svc - HRC Behavioral Health & Psychiatry virtual therapy group

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DocuSign Envelope ID: DCOCOA1D-1C9B-41B9-9927-4B65B9A4A5C4 ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: HRC Behaviorl Health & Psychiatry, P.A. Party/Vendor Contact Person: Richard E Hicks Contact Phone: 919-929-1227 Party/Vendor Address: 100 Europa Drive, Ste. 260 City Chapel Hill State: NC Zip: 27517 Department: Social Services Amount: $1,440 Purpose: virtual dialectical behavioral therapy group Budget Code(s): 10400220-761005 Vendor # NA (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7/l/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 p ' e0Wattan of the agreement: l Department Director's Signature N Slbw Date: 11/10/2020 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 sufficienc 5Kgw4_ staandards, specifications,and requirements: Office of the Risk Management Office Q�tSa C,bVw,{fb FDe Date:11/10/2020 Financial Services This instrument has been pre-audited' f ftquired by the Local Government Budget and Fiscal Control Act: (�� s��✓�Office of the Chief Financial Officer Date: 11/10/2020 Legal Services This agreement is approved as t f w end sufficiency: Office of the County Attorne Date:1111012020 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 4