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DocuSign Envelope ID: FODCEA3D-3D3B-4F1C-A2CE-98B2A861A30E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Dan Eubanks Sr. Party/Vendor Contact Person: Contact Phone: Aging Party/Vendor <br /> Address: 2300 Judah Benjamin Court City Hillsborough State:NC Zip: 27278 Department: Aging Amount: $990.00 <br /> Purpose: senior center instructor Budget Code(s): 10430120-629000 Vendor#62349 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective <br /> Date July 22,2015 Approved by Board Yes❑No❑ Agenda Date: <br /> i <br /> This agreement is approved as to technical form and content: i <br /> DocuSigned by: <br /> Department Director's Signature AIiLtU_ �d V Date: 7/27/2015 <br /> I <br /> B7E962D1BF454FA... <br /> Information Technologies <br /> I <br /> (Applicable only to hafdware/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 /> F <br /> E <br /> Risk Management ' <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned""by:''� <br /> Office of the Risk Management Officer PCs& 66vvt,e 6 Date: 7/27/2015 <br /> 7FDCF9176800498... ' <br /> td <br /> it <br /> Financial Services <br /> This instrument has been pre-audited in the planner re uired by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned byq. <br /> Office of the Chief Financial Officer �&(At 61V' Date: 7/28/2015 <br /> 232DFFC2CFA847B... � <br /> Legal Services <br /> P <br /> This agreement is approved as to legal form and sufficiency: <br /> gned by: <br /> Office of the County Attorney DocuSi Date:7/28/2015 <br /> A= <br /> 4035CB8304CA4A9... <br /> F <br /> t <br /> Clerk to the Board ' <br /> c= <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd(a(a�oran e,� count ny c• og_v I" <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 />