R 2015-299-E Health - Kevin Kirk dba Functional Fitness, LLC for group instruction for DSME program

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DocuSign Envelope ID: 325199DB-D82D-4FOE-841D-AA2307F7F5AA ORANGE COUNTY—DEPARTMENT USE ONLY Deuartment Party/Vendor Name: Kevin Kirk dba Functional Fitness, LLC Party/Vendor Contact Person: Kevin Kirk Contact Phone: 919-419-0171 Party/Vendor Address: 605 Eastowne Dr., Suite C City Chapel Hill State: NC Zip: 27514 Department: Personal Health Amount: $600 Purpose: Group instruciton for DSME program. Budget Code(s): 10414020-630000-71405 Vendor 4 62663 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7/1/2015 Approved by Board Yes❑No❑ Agenda Date: This agreement is approved as to to f L , f?i�?AufiqrFAend content: " Department Director's Signature E-e99GPG Date: 6/24/2015 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 sufficienc �mxwtfjoMandards,specifications,and requirements: ausa, (hm,&b 6/29/2015 Office of the Risk Management Officer FBSF,)47-6899449 Date: Financial Services This instrument has been pre-audited i �s ��squired by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer o�F�e Date: 6/29/2015 Legal Services This agreement is approved as t �afimaaod sufficiency: Office of the County Attorneys Date: 6/29/2015 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 5