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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> 0 <br /> Department <br /> Party/Vendor Name: University of North Carolina at Chapel Hill Party/Vendor Contact Person: Valerie Tan <br /> Contact Phone: Party/Vendor Address: 3108 Bondurant Hall, CB#7120 City Chapel Hill State: NC Zip: <br /> 27599 Department: Aging Amount: 6 00 Purpose: Fitness Studio Screenina Budget Code(s): 29430320-63000W 1� <br /> Vendor# 10419 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one) " <br /> New ❑ Renewal ® Amendment ❑ Effective Date 7/01/16 Approved by Board Yes❑ No❑ Agenda <br /> Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: <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 Risk Management �-�-� x C.�— Date: / ! to <br /> Financial Services <br /> This instrument has been pre-audited in the m er re it d y the ocal Government Budget and Fiscal Control <br /> Act: -7 <br /> Office of the Chief Financial Officer Date: l� <br /> Legal Services <br /> This agreement is approved as to legal and ff i ncy: <br /> Office of the County Attorney Date: 41416 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Q�)L Date: <br /> Revised 6/16 <br />