R 2016-335-E Aging - Connie Winstead for wellness instructor

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DocuSign Envelope ID:85CA5012-FA70-46C8-8F09-F65071A07951 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Connie Winstead Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 3000 Montgomery St City Durham State: NC Zip: 27705 Department: Aging Amount: $5,000 Purpose: Wellness Instructor Budget Code(s): 29430320-630000 Vendor#57329 (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 a�,tu. - �,r Date: 6/28/2016 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:'ll Office of the Risk Management Officer F&O, rbV7n, b Date: 6/29/2016 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 ' �ona,�am Date: 7/5/2016 7D4E5181ACC1409... Legal Services This agreement is approved as to legal form and sufficiency: DocuSigned by: Office of the County Attorney k Date: 7/6/2016 kL�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