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DocuSign Envelope ID:920E958B-BC18-461A-9F2F-998A63D4729C <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Karah Daniel, R.N. Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: P O Box 9388 City Chapel Hill State: NC Zip: 27515 Department: Aging Amount: $5,000.00 Purpose: <br /> wellness instructor Budget Code(s): 29430320-622000 Vendor 4 63090 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 1, <br /> 2015 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature « <br /> Date: 6/22/2015 <br /> B7E962D1BF454FA... <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 Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned""by: <br /> ''111L <br /> Office of the Risk Management Officer allStU (hVV,&b Date: 6/22/2015 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the WaT e�ripwred by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer b�' Date: <br /> 6/22/2015 <br /> 232DFFC2CFA847B... <br /> Legal Services <br /> This agreement is approved as to 74035CB8304CA4Ag arq sufficiency: <br /> gne y: <br /> Office of the County Attorney � � Date: 6/23/2015 <br /> ... <br /> Clerk to the Bo ard <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/14 4 <br />