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DocuSign Envelope ID:F5F38958-9442-4472-A709-F5D97CE67E1A <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Toni Shaw Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: <br /> 1301 Deerfield Trace City Mebane State: NC Zip: 27302 Department: Aging Amount: $3,000 Purpose: Wellness <br /> Instructor Budget Code(s): 29430320-630000 Vendor#61838 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date July 1, 2016 <br /> Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technigal form and content: <br /> ocuSigned by: <br /> Department Director's Signatur <br /> rj�t& -Ar�'r Date: 6/28/2016 <br /> B7E962D1BF454FA... <br /> Information Technologies <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: <br /> FDocuSigned <br /> liSa ,,__ ••llll 6/29/2016 <br /> Office of the Risk Management Officer vvullb Date: <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 /> DocuSigned by. <br /> Office of the Chief Financial Officer 16.&. Date:7/5/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney Date: 7/6/2016 <br /> 4035CB8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync•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 6/16 5 <br />