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DocuSign Envelope ID: CF3B53E6-A7C6-4401-9C8F-158C21168A54 <br /> �I <br /> 'I <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> �I <br /> Department <br /> i <br /> Party/Vendor Name: Michael Saving Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 505 Long Leaf Drive City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: $3,000.00 <br /> Purpose: wellness instructor Budget Code(s): 29430320-630000 Vendor#44715 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date <br /> July 22,2015 Approved by Board Yes❑No❑ Agenda Date: <br /> E <br /> This agreement is approved as to technicaal fonrm�pd content: <br /> QocuSigned5'y: <br /> 5 a�n,iU_ fi( ,ir 7/27/2015 <br /> Department Director's Signature Date: <br /> B7E962D1 BF454FA... <br /> i <br /> Information Technologies <br /> r <br /> 14 <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 /> 4 <br /> G <br /> Office of the Chief Information Officer Date: <br /> r: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned by: <br /> '" '� 7/27/2015 <br /> Office of the Risk Management Officer PCs& r,6vvt,e,tt0 Date: L <br /> 7FDCF9176800498... ri <br /> Financial Services <br /> This instrument has been pre-audited in the plan err wired by the Local Government Budget and Fiscal Control Act: <br /> --IocuSigned�: <br /> �&(A b�L 7/28/2015 <br /> Office of the Chief Financial Officer Date: <br /> 232DFFC2CFA847B... <br /> die <br /> Legal Services e <br /> t; <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney, � Date: 7/28/2015 <br /> 4035C 28304CA4A9... <br /> is <br /> Clerk to the Board <br /> r <br /> i <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd a,oran eg countync..ov <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 /> i <br /> 't <br /> f <br /> Revised 10/14 4 <br />