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DocuSign Envelope ID: 167D54A6-3C3B-447B-9223-674D7AB95BA5 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Katherine Leith Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 36 Clover Lane City Chapel Hill State: NC Zip: 27517 Department: Aging Amount: $4,000 Purpose: <br /> Senior Times Budget Code(s): 10430120-629000 Vendor # 52922 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No[] Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date <br /> 07/15/16 Approved by Board Yes❑Nor-1 Agenda Date: <br /> This agreement is approved as to technical form end content: <br /> hh ocu5igne by: <br /> J Date: 7/13/2016 <br /> Department Director's Signature AVtdGt <br /> 67E962D1BF454FA... <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 /> Docu5ig/'ned""by: <br /> ''11i1 <br /> Office of the Risk Management Officer &. (,6rvu,f 16 Date: 7/14/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner rsequired by the Local Government Budget and Fiscal Control Act: <br /> ocuSigned y: <br /> Office of the Chief Financial Officer 7/14/2016 <br /> Fel�� s�oraR,�losz Date: <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to le qj,fi, }e�> sufficiency: <br /> Office of the County Attorney 1111_ Date 7/18/2016 <br /> 4035CE8334CA4A9... <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 />