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CONTRACT STATUS FORM
RECEIVED
96 O
DATE: December 01, 2021Es�
AUG 26222
DIVISION(S): Public Health Nursing
(Lead Division listed first) DEPARTMENT
OF UECTI ALTH
CONTRACTCONTRACTOR: Community Action Partnership of Madera County
SERVICES: MOU: Coordination of CHDP & Fresno Migrant Head Start Program
CONTRACT TERM: 7/1/17 to 6/30/22 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): N/A
CONTRACT AMOUNT: $0.00
Contract#: M-11-758 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:March 1, 2022
Extend contract through: , 20
With no changes in terms or conditions.
With the following change(s):
® Evergreen: Continue contract through: ;Lne '22� , 20 22)
❑ Cancel contract effective: 120
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervisor/Staff Analyst: j Date: $/Z5/2-7
Division Manager: Date: V 291A"L
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090