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ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department O( lQ <br /> Party/Vendor Name: Michael Saving Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 505 Long Leaf Dr City Chapel Hill State: NC Zip: 27517 Department: Aging Amount: 12 00 urpose: <br /> Wellness Instructor Budget Code(s): 29430320-63000 dor#44715 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes❑No❑ Contract Type: (Check one) ❑ Renewal ® Amendment ❑ Effective Date August <br /> 22,2016 Approved by Board Yes❑No® Agenda ate: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature ic"'." Date: S-' 2r-,16 <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 `Date: raZ ` t6 <br /> FiAancial SiWces <br /> This instrument has been pre-audited in the man a require y e L al Government Budget and F*scal Control Act: <br /> Office of the Chief Financial Officer Date: ��< <br /> V i — <br /> Legal Services <br /> This agreement is approved as to legal d suf ie 3c ____",Office of the County Attorney Date: t <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd n completion Dolloy�oran eg countync.gov <br /> The following signature block is for hard copies only n n quir for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 6/16 5 <br />