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DocuSign Envelope ID:95F60F07-6410-45F7-BAA6-D073A381B85A <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Nina Maier Party/Vendor Contact Person: Contact Phone: (919)732-2722 Party/Vendor <br /> Address: 3302 Pearson Road City Hurdle Mills State: NC Zip: 27541 Department: DEAPR Amount: $2464.00 <br /> Purpose: Tai Chi Instruction Budget Code(s): 10511020 630000 Vendor#51178 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No[] Contract Type: (Check one)New❑ Renewal❑ Amendment ❑ Effective Date <br /> Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> 5DocuSigned by: <br /> Department � sw Ul Director's Signature Date8 i>z i�ti <br /> 611CFA1D507A495... <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 /> DocuSigned by: <br /> Office of the Risk Management Officer Pausa, (,OV'vtd 6 Date: 6 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner rewired by the Local Government Budget and Fiscal Control Act: <br /> DocuSi ed by: <br /> Office of the Chief Financial Officer ('l� �°n Date: 8/9/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> uSigned by: <br /> Office of the County Attorney 56Z, r6u�s Date: <br /> EAAMKEDM8465... 8/9/2016 <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.plc.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 />