R 2015-112-E Aging - Jan Gittelman for clogging classes

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DocuSign Envelope ID:2744CF92-DCCB-4858-8AD8-1B429F1A1590 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Jan Gittelman Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 2406 Buck Quarter Farm Rd City Hillsborough State:NC Zip: 27278 Department:Aging Amount: $990.00 Purpose: clogging classes Budget Code(s): 10430120-629000 Vendor 4 N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 0111512015 Approved by Board Yes❑No❑ Agenda Date: This agreement is approved as to technical form and content: DocuSigned by: Department Director's Signature �AW«- bur Date: 1/10/2015 B7E962D1BF454FA... Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: --DocuSigned�"by: 11LL Office of the Risk Management Officer a�lSa (,bnL&b Date: 1/12/2015 7FDCF9176800498... Financial Services This instrument has been pre-audited in the mape�rigreq .Mired by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer F _)_ V�Rti Date: 1/15/2015 2F982EC44=444... Legal Services This agreement is approved as to legal form and sufficiency: DocuSigned by: Office of the County Attorney Date: 1/15/2015 4085CB8304CA4A9... Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 10/14 4