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DocuSign Envelope ID:451855F0-5EC3-471 B-A519-9B26FC68FF69 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Michelle Rogers, Inc. Party/Vendor Contact Person: Contact Phone: <br /> Party/Vendor Address: 210 Virginia Lee Lane City Efland State: NC Zip: 27243 Department: Aging Amount: <br /> $800.00 Purpose: Wellness Instructor Budget Code(s): 10430120-770105 Vendor # 64462 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date 5/01/17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to technicalDformnan content: <br /> ocu Department Director's Signature <br /> a�,tu 1-Y,G ' Date: 5/24/2017 <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 /> r----DocuSigned by: <br /> q � 5/25/2017 <br /> Office of the Risk Management Officer ausa rtAk116 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 /25/2017 <br /> �a� �°".�a°'z Date:ate: <br /> -7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> r--DocuSigneed"byy:'hark,Attorney ate, VVW&Yk, -I-.SCb 5/25/2017 <br /> Office of the Coun Attorne Date: <br /> `—079A4D525C0F4FB... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.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 2/17 5 <br />