R 2016-390-E Aging - Stephanie Yost for wellness instructor

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DocuSign Envelope ID: CBBE423A-9D53-4533-93A1-4DAB6416895F ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Stephanie Yost Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 7700 Amesbury City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: $5,000 Purpose: Wellness Instructor Budget Code(s): 29430320-630000 Vendor#34784 (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 forth and content: Docu5igned by: Department Director's Signature Date: 6/28/2016 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: FaDocuSigned by:''1111 Office of the Risk Management Officer llSA. r,6nAA�16 Date: 6/29/2016 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: 7/21/2016 7D4E5181ACC1409... Legal Services This agreement is approved as to legal form and sufficiency: igned by: Office of the County Attorney DocuS Date: 7/22/2016 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