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DocuSign Envelope ID:6715A5E3-38C0-41CD-A4A6-DC9FD2F818D7 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Nina Maier Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: <br /> 3302 Pearson Rd City Hurdle Mills State: NC Zip: 27541 Department: Aging Amount: $3,000 Purpose: Wellness <br /> Instructor Budget Code(s): 29430320-630000 Vendor#51178 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date July 15, 2016 <br /> Approved by Board Yes❑No[] Agenda Date: <br /> This agreement is approved as to technical forth and content: <br /> 5igned by: <br /> 5Z& <br /> Department Director's Signature �v Date: <br /> 7/19/2016 <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 /> Docu5igned""by:''11i1 <br /> Office of the Risk Management Officer Q�Sa �,Orvu X16 Date: 7/19/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the tnwnEr required by the Local Government Budget and Fiscal Control Act: <br /> ocu igned y: <br /> Office of the Chief Financial Officer <br /> F� `�°'�" �°'v Date: 7/20/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to le al for t�sufficiency: <br /> Doc.pa <br /> oe y. <br /> 7/20/2016 <br /> Office of the County Attorney r� � Date: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 />