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DocuSign Envelope ID:3E6B5F62-1B34-4EF0-8839-959030955648 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Lorraine Lewis Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 107 Momingside Drive City Carrboro State: NC Zip: 27510 Department: Aging Amount: $1,500 Purpose: <br /> Wellness Instructor Budget Code(s): 29430320-630000 Vendor# 57608 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑No❑ Contract Type: (Check one)New ❑ Renewal® Amendment ❑ Effective Date July 1, <br /> 2016 Approved by Board Yes❑No[] Agenda Date: <br /> This agreement is approved as to techni IEgrmAn d content: <br /> JDepartment Director's Signature �WAA* _ Date:6/28/2016 <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 /> DocuSigned""by..'11i1 <br /> Office of the Risk Management Officer &. (,6rvu,f 16 Date: 6/29/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by. <br /> Office of the Chief Financial Officer Date: 7/21/2016 <br /> ('� �osr�2osz <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 Date: 7/22/2016 <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 />