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DocuSign Envelope ID: BBEB91 D3-16B0-4295-9E85-F947DC32EFAA <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> NOT A CONTRACT EXHIBIT OR ATTACHMENT <br /> Department <br /> Party/Vendor Name: Party/Vendor Contact Person: Nina Maier Contact Phone: (919)732-2722 Party/Vendor <br /> Address: 3302 Pearson Road City Hurdle Mills State: NC Zip: 27541 Department: DEAPR Amount: $1600.00 <br /> Purpose: Tai Chi Instruction Budget Code(s): 10511020 630000 Vendor 4 51178 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date <br /> September 1,2014 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form @M td by: <br /> ��� Sfa�u� 9/3/2014 <br /> Department Director's Signature sFal�so,�4se Date: <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 Director of Information Technology Date: <br /> Risk Management <br /> This agreement is approved for suf llegPE"i -iA§urance standards,specifications,and requirements: <br /> Q rbvvull0 9/4/2014 <br /> Office of Risk Management 7FDCF9176800498_ Date: <br /> Financial Services <br /> This instrument has been pre-audited in the in rnn g 0fUq@lq*�by the Local Government Budget and Fiscal Control Act: <br /> ��� � <br /> Office of the Chief Financial Officer V�R� Date: 9/4/2014 <br /> Legal Services <br /> This agreement is approved as to legal rTW W'W�ftie cy: <br /> JJ ��,,�� 9/4/2014 <br /> Office of the County Attorney EBAami f]SAB46.i_ Date: <br /> Clerk to the Board <br /> Received for record retention: oocu8igned by: <br /> �bl�t In a JjA�t V 9/4/2014 <br /> Office of the Clerk to the Board 7�1R,F��R, Date: <br /> Revised 7/14 4 ff <br />