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DocuSign Envelope ID:494289F0-8E30-4C81-8483-99B39200A68F <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Jennifer Sugg Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: PO Box 272 City Bynum State: NC Zip: 27228 Department: Aging Amount: $2,500 Purpose: Fit Feet <br /> nurse Budget Code(s): 29430320-622000 Vendor#63091 (N/A if new vendor) Vendor is a BOCC consultant? Yes <br /> ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date August 10, 2016 <br /> Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature � 1GL :�'r Date: 8/20/2016 <br /> B7E962D1BF454FA... <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 /> Fmso,DocuSigned_by:'ll g (hn tl6 8/22/2016 <br /> Office of the Risk Mana ement Officer Date: <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by'. <br /> Office of the Chief Financial Officer ��� Date: 8/22/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to lei 1 fi %nd sufficiency: <br /> ocu igned T. <br /> Office of the County Attorneys Date: 8/23/2016 <br /> 4035CB8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync•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 />