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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> NOT A CONTRACT EXHIBIT OR ATTACHMENT <br /> Department <br /> Party/Vendor Name: Kim Werfel Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: <br /> 120 Fearrington Post City Pittsboro State: NC Zip: 27312 Department: Aging-CBS Amount: $1,800.00 Purpose: <br /> Instructor Budget Code(s): 10430120-629000 Vendor#62647 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 09/01/14 Approved <br /> by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature .X. Date: <br /> lo <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 sufficiency of insurance standards,specifications,and requirements: <br /> Office of Risk Management (i(,�t.�r �._. Date: t SEP 9 2014 <br /> By <br /> Financial Services <br /> This instrument has been pre-audited in the nner required by he Log Government Budget and Fiscal Control Act: <br /> Office of the Chef Financial Officer <br /> � Date: <br /> °L l lS <br /> Legal Services <br /> This agreement is approved as to legal f nd s ciency: <br /> Office of the County Attorney Date: <br /> Revised 7/14 4 <br />