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DocuSign Envelope ID: D0743AF4-A904-420B-8ADC-488A6EF131AC <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Nancy Alton Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 3917 Marklyn PI City Hillsborough State: NC Zip: 27278 Department: Aging Amount: $3,000 Purpose: <br /> Wellness Instructor Budget Code(s): 10430120-630000-71085 Vendor# 58145 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date <br /> July 15,2016 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Docu5igned by: <br /> 7/13/2016 <br /> Department Director's Signature � '�� Date: <br /> 67E962D18F454FA... <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 /> Docu5igned by: <br /> Office of the Risk Management Officer pllS. (,6nAA 11i1 6 Date: 7/14/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the Wan age erdevmred by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer (� `�°'�"��°'v Date: 7/14/2016 <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 In,_ Date: 7/18/2016 <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 6/16 5 <br />