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DocuSign Envelope ID: 5D5A595E-2BB6-4DD8-9F77-030F1CC8DC59 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Karen Weaver Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 431 Hampton Pointe Blvd City Hillsborough State: NC Zip: 27278 Department: Aging Amount: $720.00 <br /> Purpose: Wellness classes Budget Code(s): 29430320-630000 Vendor# 63615 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No[] Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date <br /> 02/29/16 Approved by Board Yes❑Nor-1 Agenda Date: <br /> This agreement is approved as to technical forth and content: <br /> 5igned by: <br /> Department Director's Signature 5Z& fi�v Date: 2/24/2016 <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 /> DocuSigned""by: <br /> ''11i1 <br /> Office of the Risk Management Officer P&a, (,6rvu,�16 Date: 2/24/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> ocuSigned y. <br /> Office of the Chief Financial Officer Fel� `�°'�" �°'v Date: 2/25/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to le al�rtt�an4 sufficiency: <br /> ocu igne by: <br /> Office of the County Attorney "',_ Date: 2/29/2016 <br /> 4035CE8304CA4A9... <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 />