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DocuSign Envelope ID: 28A5E40A-FF10-4F0E-ACB6-711F2F7F2DFF <br />Anoka County <br />A0 HUMAN SERVICES DIVISION <br />Community Social Services and Behavioral Health <br />April 25, 2023 <br />City of Centerville <br />Attn: Mark Statz <br />1880 Main Street <br />Centerville, MN 55038 <br />Dear Mr. Statz: <br />Enclosed is your 2023 contract with Anoka County. Please review the contract and complete the signature portion using <br />DocuSign. If applicable and ready, please attach the necessary insurance information using the attachment link in the <br />DocuSign document. If insurance is not ready and you will be sending this information at a later date, please send to: <br />Angie Rodine <br />An L ela.Rodinee%!.co.anoka,mnus or County of Anoka <br />2100 3rd Avenue, 5th Floor <br />Anoka, MN 55303 <br />PLEASE NOTE: The following information is required as part of your contract; If the contract is signed and executed <br />without receiving this information in a timely manner, it may be referred to the County Attorney's Office for possible <br />Breach of Contract andlor payments may be withheld until information is received <br />CERTIFICATE OF LIABILITY INSURANCE - Reyuired <br />No insurance information is needed for this contract. <br />CONTRACTOR INFORMATION SHEET — Rewired <br />Please update/complete and sign this page and return with your contract. <br />DocuSign will automatically forward a copy of the signed contract to you, once completed. If you have questions regarding <br />the contract, please call your Contract Manager, Justin Navratil, at 763-324-4336. <br />Sincerely, <br />Angie Rodine <br />Administrative Assistant, Planning and Operations Support Services <br />Meeting People's Needs Through Quality Services <br />Community Social Services & Behavioral Health <br />Government Center ♦ 2100 3rd Avenue N, STE 500 ♦ Anoka, MN 55303-5049 <br />PHONE:763-324-1400 ♦ FAX:763-324-1110 <br />Affirmative Action I Equal Opportunity Employer <br />