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DocuSign Envelope ID: BA2C9714-6E23-4C44-906C-9D17CC0719D6 UNC SOM#22-0715 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: UNC School of Medicine Department of Psychiatry Party/Vendor Contact Person: Matthew <br /> O/neal,Associate Chair of Administration Contact Phone: 919-445-0230 Party/Vendor Address: 372 Medical School <br /> Wing D CB#7160 City Chapel Hill State:NC Zip:27599-7160 Department:CJRD Amount:$317,824($292,824 for <br /> In-Pt physician services and Out-Pt Crisis and$25,000 for Jail Psychiatry) Purpose: Managed Care Psychiatry Sevices <br /> and Jail Contract Psychiatry Budget Code(s): 10420020-710050 Vendor#49882 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date <br /> 7/1/21 Approved by Board Yes®No❑ Agenda Date: 6/15/21 <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 /> DocuSigned by: <br /> Department Director's Signature �"` V' � Date: 1/3/2022 <br /> Agreements for emergency services WHFWsubject 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 /> DocuSigned by: 1 <br /> b <br /> Office of the Risk Management Office Aura, COVInt Date: 1/3/2022 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in thgopj �&pquired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Office r Date:1/4/2022 <br /> re <br /> au�e/smrL <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to le 1 fg9mnd sufficiency: <br /> ned by: <br /> Office of the County Attorney L_ 079A4D525C0F4FB <br /> bi &L, 'V� it, T6S(b Date:1/5/2022 <br /> ... <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 /> Orange County Managed Care Fund Performance Agreement Page 7 of 9 <br /> Rev. 912021 <br />