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DocuSign Envelope ID: CE03F77E-2613-496A-9C6E-F11685DF6CDA <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Nathaniel Shapiro Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 2701 Homestead Rd, Apt #113 City Chapel Hill State: NC Zip: 27516 Department: Aging Amount: <br /> $3,000.00 Purpose: Fitness Studio Budget Code(s): 10430120-630000-71085 Vendor# 63616 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date 02/29/16 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical forth and content: <br /> Docu5igned by: <br /> Department Director's Signatur ,WAA*a. JA' W Date: 2/23/2016 <br /> 67E962D1BF454FA... <br /> Information Technolosies <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 /> / ""by:��1111 <br /> Office of the Risk Management Officer <br /> FDocuSigned <br /> uSA. ('6M c& Date: 2/24/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in th gnmq"ired by the Local Government Budget and Fiscal Control Act: <br /> ,��..�,�,/� <br /> Office of the Chief Financial Officer rl� Date: 2/26/2016 <br /> 7D4E 181ACC1409... <br /> Legal Services <br /> This agreement is approved as to 1 �,k�t, sufficiency: <br /> Office of the County Attorney � .- Date: 2/29/2016 <br /> 4035CB8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.gov <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 1/16 4 <br />