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ORANGE COUNTY—DEPARTMENT USE ONLY r) 383 <br /> Department <br /> Party/Vendor Name: Nancy Dede Banks Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 747 Rock Rest Rd City Pittsboro State: NC Zip: 27312 Department: Aging Amount: 000 Purpose: <br /> Wellness Instructor Budget Code(s) 9430320-630000 Vendor#55776 (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 l (/ Date: — J° <br /> Financial Services <br /> This instrument has been pre-audited in the er u ed the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer . Date: 2S <br /> Legal Services <br /> This agreement is approved as to legal f and sufficiency: <br /> Office of the County Attorney Dater (o <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@oran eg coun nc.gov <br /> The following signature block is for hard copies d' not r quired for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 6/16 5 <br />