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DocuSign Envelope ID:6647E338-085A-4D3E-B45C-6D9ECB0533C1 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Functional Fitness, LLC Party/Vendor Contact Person: Kevin Kirk Contact Phone: <br /> Party/Vendor Address: 5311 Beaumont Dr City Durham State:NC Zip: 27707 Department: Aging Amount: $12,000 <br /> Purpose: Wellness Instructor Budget Code(s): 29430320-630000 Vendor#34783 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date <br /> July 21,2016 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technil f�aigmnd content: <br /> CE& fi(�r Department Director's Signature Date: 7/19/2016 <br /> 62D18F454FA... <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 /> Docugned by: 1111 Office of the Risk Management Officer FauSi <br /> s . ('6'n' & Date: 7/19/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the,om rmngbyequired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer E7D4E5181ACC1409�_ Date: 7/20/2016 <br /> . <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney s Date: 7/20/2016 <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 />