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DocuSign Envelope ID: 12D4206E-OD82-4E82-BF44-D5FD9591E67C <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Karah Daniel Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: PO Box 9388 City Chapel Hill State: NC Zip: 27515 Department: Aging Amount: $2,500 Purpose: Fit <br /> Feet nurse Budget Code(s): 29430320-622000 Vendor#63090 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date July 20, 2016 <br /> Approved by Board Yes❑No[] Agenda Date: <br /> This agreement is approved as to technical forth and content: <br /> Docu5igned by: <br /> Department Director's Signatur �WAA*U_ ��W Date: <br /> 7/22/2016 <br /> B7E962D1BF454FA... <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 /> Docu5igned by: 11i1 <br /> Office of the Risk Management Officer pllS. ('6nA '',ll b Date: 7/25/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the oDtn��g ed�ry.quired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: 7/28/2016 <br /> (� s�oraR,�losz <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney 5 Date: 7/29/2016 <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 />