R 2016-333-E Aging - Janice Galloway for Fit Feet nurse

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DocuSign Envelope ID:E9EF5F09-83C7-48AB-B736-FC3D8CO2309A ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Janice Galloway Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 6615 Glen Forest Dr City Chapel Hill State: NC Zip: 27517 Department: Aging Amount: $6,000 Purpose: Fit Feet nurse Budget Code(s): 29430320-622000 Vendor # 58613 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date July 1, 2016 Approved by Board Yes❑No® Agenda Date: This agreement is approved as to technical form and content: DocuSigned by: Department Director's Signature Date:6/27/2016 B7E962D1BF454FA... Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: DocuSigned_by:' Office of the Risk Management Officer F&O, r,6nUff6 Date: 6/28/2016 7FDCF9176800498... Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: Office of the Chief Financial Officer Date: 7/3/2016 7D4E5181ACC1409... Legal Services This agreement is approved as to legal form and sufficiency: DocuSigned by: Office of the County Attorney Da.te:7/6/2016 4035CB8304CA4A9... Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync•gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 6/16 5