Orange County NC Website
Browse       Search
ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Seine Wolfe Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 909 Palmers Grove Church Rd City Hillsborough State: NC Zip- 27278 Department: Aug Amount: <br /> $2,000 Purpose: Wellness Instructor Budget Code(s): 10430120-770105t/Vendor # 58051 (N/A if new vendor)— k� <br /> Vendor is a BOCC consultant? Yes ❑ Nor-1 Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ v�r � <br /> Effective Date August 15,2016 Approved by Board Yes[]No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: Jk-/040 <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 /> Office of the Risk Management Officer b <br /> Fin cial Wrvices <br /> This instrument has been pre-audited in the marine r qu' b the cal Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: g/S <br /> V/I t-, - F - <br /> Legal Services <br /> This agreement is approved as to legal fo suf c y: <br /> Office of the County Attorney Date: `I <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountvnc.gov <br /> The following signature block is for hard copies y s n required for Docusign contracts: <br /> Office of the Clerk to the Board Date:`[(, <br /> Revised 6/16 5 <br />