R 2016-371-E Aging - Martha Broda for wellness instructor

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DocuSign Envelope ID: D4EC3B36-C7FE-496E-AOC9-CDF8C55334AB ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Martha Broda Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 1388 Manus Chapel Rd City Pittsboro State: NC Zip: 27312 Department: Aging Amount: $2,000 Purpose: Wellness Instructor Budget Code(s): 29430320-630000 Vendor# 58627 (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: Docu5igned by: Department Director's Signature � �� Date: 7/10/2016 67E962D18F454FA... Information Technolosies (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:''11i1 Office of the Risk Management Officer allSA. ('6nt,ll b Date: 7/11/2016 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 Date: 7/16/2016 7D4E5181ACC1409... Legal Services This agreement is approved as to legal form adnbd sufficiency: Office of the County Attorney r Date: 7/18/2016 4035CE8304CA4A9... Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.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