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DocuSign Envelope ID:FlB31172-6DD2-4B45-AEBD-1CA1925823FC <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Nina Maier Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: <br /> 3302 Pearson Rd City Hurdle Mills State: NC Zip: 27541 Department: Aging Amount: $4,000 Purpose: Wellness <br /> Instructor Budget Code(s): 29430320-630000 Vendor#51178 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 7/01/17 Approved <br /> 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 jLlAA L- � Date: 6/27/2017 <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 a�iS& by:'ll <br /> Office of the Risk Management Officer rbYliut 16 Date: 6/27/2017 <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 /> -- <br /> ,- –DocuSigned y: <br /> 6/27/2017 <br /> Office of the Chief Financial Officer �� Date:-7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> p--DocuSigneenO4 ftd,,by��:♦�-�� <br /> Office of the County Attorney <br /> 0.t,u, 1✓ hark, 1 SCb Date: 6/27/2017 <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 />