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DocuSign Envelope ID: F6CD8250-2AB4-4A11-B4D8-9974EFB1B1A6 <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: $1.792.00 <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 to r-vL'�rs r%d c ntent: <br /> 'l 8/21/2016 <br /> Department Director's Signature n„cF Date: <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 sufficienc I�womn tvstandards, specifications,and requirements: <br /> QUSA, (hVV,c,�16 8/22/2016 <br /> Office of the Risk Management Officer�PnrPa,7RRnnAQ Date: <br /> Financial Services <br /> This instrument has been pre-audited i e114MMh'&P�quired by the Local Government Budget and Fiscal Control Act: <br /> 8/22/2016 <br /> Office of the Chief Financial Officer Lita <br /> SFSaslariAn4 Date: <br /> Legal Services <br /> This agreement is approved as t e 118HUlaW•d,�ssu,fficiency: <br /> 6 r6ufs 8/22/2016 <br /> Office of the County Attorney Date: <br /> AA <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 /> DS <br /> D <br />