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ORANGE COUNTY-DEPARTMENT USE ONLY _ 2 p� <br /> Department J U <br /> Party/Vendor Name: William Meyers Party/Vendor Contact Person: Contact Phone: Partyyendor <br /> Address: 1204 Little Creek Rd Ci �- Z94T30320-6300TO ham State: NC Zip: 27713 Department: A in Amount: 1 500 urpose: <br /> Wellness Instructor Budget Code(s Vend or# 56366 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑No❑ Contract Type:(Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 31, <br /> 2016 Approved by Board Yes[]No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: <br /> Information Technologies <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 /> Office of the Risk Management Officer �t.� ( � Date:�b <br /> Financial Services <br /> This instrument has been pre-audited in the manner r it y e cal Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: 2S 4 <br /> Legal Services <br /> This agreement is approved as to legal fo d suff ie c <br /> 2 <br /> Office of the County Attorney Date: � -b <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloXdgoran eg countvnc.gov <br /> The following signature block is for hard cop. y nd is of required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 6/16 5 <br />