R 2016-415-E Aging - Nathaniel Shapiro for wellness instructor

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DocuSign Envelope ID:593338F8-59C1-4A9D-92DC-A91318C543A3 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Nathaniel Shapiro Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 2701 Homestead Rd City Chapel Hill State: NC Zip: 27516 Department: Aging Amount: $6,000 Purpose: Wellness Instructor Budget Code(s): 10430120-630000-71085 Vendor# 63616 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date July 15,2016 Approved by Board Yes❑ No® Agenda Date: This agreement is approved as to technicahfp.rin. n'allycontent: ,tu (�y 7/28/2016 Department Director's Signature Date: B7E962D1BF454FA... Information Technologies (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: Fmso,DocuSignedby:'ll Office of the Risk Management Officer (hnutl6 Date: 7/29/2016 7FDCF9176800498... Financial Services This instrument has been pre-audited in the&7AMW-d%quired by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer [_�4N Date: 7/29/2016 7D4E5181ACC1409... Legal Services This agreement is approved as to le al�g gq oufficiency: Office of the County Attorney Date: 8/1/2016 4035CB8304CA4A9... Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync•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