HomeMy WebLinkAboutAgreement A-21-378 with CalMHSA.pdfDocuSign Envelope ID : 339426B0-4768-4BF8-A1 F8-7D52FD9A64B7
Agreement No . 21-378
Agreement No . 599-EHR-2021-FC
CALIFORNIA MENTAL HEALTH SERVICES AUTHORITY
PARTICIPATION AGREEMENT
EHR PROGRAM
1.
2.
Fresno County ("Participant"} desires to participate in the EHR Program ("Program"}.
California Mental Health Services Authority ("CalMHSA"} and Participant acknowledge that the
Program will be governed by CalMHSA's Joint Powers Agreement and its Bylaws, and by this
participation agreement ("Agreement"}. The following exhibits are incorporated into the
Agreement.
Exhibit A
Exhibit B
Program Description and Funding Allocation
General Terms and Conditions
3 . The Funding Amount under this Agreement is $150,000 .00.
4. Funds payable under this agreement are subject to reversion :
D Yes : Reversion Date _____ _
IZI No
5. The Term of the Program is (12) months, beginning July 1, 2021 and terminating on June 30, 2022,
with the option for early termination or extension.
6. During the Term, Participant will not initiate any new engagement with any other entity or vendor
to provide the services contemplated under the Program.
7 . Authorized Signatures :
CalMHSA
~
DocuSlgned by :
Signed: 1Y.iL-M.illt..r
21 IQOCA30878'06 ...
Title: Executive Director
Email: amie.miller@calmhsa .org
Participant:
Signed :
Name (Printed): Dr. Amie Miller, Psy.D., MFT
Date : 9/2/2021
Name (Printed): Steve Brandau
Title: Chairman of the Board of Supervisors of the County of Fresno Date : ~ ~ · oil ·~.;;)....\
ATTEST:
BERNICE E . SEIDEL
Clerk of the Board of Supervisors
CountY. of Fresno , State of California
By d ,rv .. ~,, ~
Deputy
Fresno County-Participation Agreement