R 2016-339-E Health - Kevin Kirk dba Functional Fitness, LLC for group instruction for DSME program

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DocuSign Envelope ID:D8CCE739-BC40-475F-83D5-EB8CB65D9E58 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Kevin Kirk dba Functional Fitness, LLC Party/Vendor Contact Person: Kevin Kirk Contact Phone: 919-419-0171 Party/Vendor Address: 605 Eastowne Dr., Suite C City Chapel Hill State: NC Zip: 27514 Department: Health Amount: $600 Purpose: Group instruciton for DSME program. Budget Code(s): 10414020- 630000-71405 Vendor#62663 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7/1/2016 Approved by Board Yes❑ No❑ Agenda Date: This agreement is approved as to to 1 T1 'AY1d content: �- 7/6/2016 Department Director's SignatureE FGGB545E Date: 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 sufficienc m r9Haaeystandards, specifications, and requirements: Q�ISa C,bvwc,116 7/6/2016 Office of the Risk Management Officer eeF�hn Date: Financial Services This instrument has been pre-audited iryttwWfiYAWW&Yquired by the Local Government Budget and Fiscal Control Act: p ° `"` 7/6/2016 Office of the Chief Financial Officer ��eaFc, os Date: Legal Services This agreement is approved as t eg°a4`M `'ft sufficiency: �� Office of the County Attorney -� Date: 7/6/2016 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(a�oran.eg count, nc.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 4