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DocuSign Envelope ID: 38143D20-59F4-4FOF-B43E-EFE72B63OE83 <br /> A c <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> is <br /> Department <br /> Party/Vendor Name: Ruth Merrick Parry/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 215 S. Hillsborough Ave City Hillsborough State: NC Zip: 27278 Department: Aging Amount: $3,000.00 <br /> Purpose: senior centers instructor Budget Code(s): 10430120-629000 Vendor#58822 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective <br /> Date September 15,2015 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 Jiu- fi Date: 9/14/2015 <br /> B7E9=1 BF454FA._ <br /> Information Technologies <br /> C <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is r <br /> r- <br /> approved as to information technology content and specifications: <br /> i' <br /> Office of the Chief Information Officer Date: <br /> f <br /> I <br /> Risk Management <br /> t <br /> f; <br /> i <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned by: <br /> ''"" ''11LL i <br /> Office of the Risk Management Office aura vvt,e 6 Date. 9/15/2015 <br /> 7FDCF9176800498... <br /> L <br /> Financial Services <br /> is <br /> I <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officerx Date: 10/28/2015 <br /> 7D4E5181ACC1409... <br /> r <br /> Legal Services <br /> r <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney po Date: 10/29/2015 <br /> 4035CB8304CA4A9... I. <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloda,oran eg countync. ov <br /> 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 /> j, <br /> Revised 10/14 4 <br />