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DocuSign Envelope ID: E9DOCDAB-7830-4405-94B8-CO2D52F79427 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Southern Health Partners Party/Vendor Contact Person: Jeannette Rodrijzuez Contact Phone: <br /> 423-553-5635 ext.922 Party/Vendor Address:2030 Hamilton Place Blvd,Ste 140 City Chattanooga State:TN Zip: <br /> 37421 Department: BOCC Amount: $390,017.64 Purpose: Medical Services for Inmates Budget Code(s): <br /> 10715020-63000 Vendor#59271 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract <br /> Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date July 1,2022 Approved by Board Yes <br /> ®No❑ Agenda Date:June 7,2022 <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 /> D�ocu"S'igned by: <br /> S�" " 66 C�nRe A �Q�i,�a '�ssd 6/14/2022 <br /> Department Director's Signature aBBAECFSD62944B... Date: <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 o ms VVhk& <br /> it�fidards,specifications,and requirements: <br /> aura. 6/14/2022 <br /> Office of the Risk Management Officer 7FDCF9176800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited in the 4e? gkyd by the Local Government Budget and Fiscal Control Act: <br /> 01.� 6/15/2022 <br /> Office of the Chief Financial Officer uNC-1 e9 Date: <br /> Legal Services <br /> This agreement is approved as to lea f�lS f Mfficiency: <br /> b Outs 6/16/2022 <br /> Office of the County Attorney EA------------- Date: <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 /> Do,p ned b <br /> The following signature block is for and o� pi�s�ony and is not required for Docusign contracts: <br /> 6/16/2022 <br /> Office of the Clerk to the Board DO BUAD28C12411... Date: <br /> Revised 07/20 <br />