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DocuSign Envelope ID:A88B52D1-F83A-4024-B98D-A2DDO9F7BED6 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Kevin Kirk Party/Vendor Contact Person: Kevin Kirk Contact Phone: 919-419-0171 <br /> Party/Vendor Address: 5311 Beaumont Drive City Durham State: NC Zip: 27707 Department: Health Amount: $600 <br /> Purpose: Group instruciton for DSME program. Budget Code(s): 10414020-630000-71405 Vendor# 34783 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ❑ Renewal <br /> Amendment ❑ Effective Date 7-1-17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to to c°RI 1`iid content: <br /> UM, tlAb 6/29/2017 <br /> Department Director's Signature F,4saa�e�a5s4aF 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 sufficient q soli :standards,specifications,and requirements: <br /> l(UStt C,ortA ft b 6/29/2017 <br /> Office of the Risk Management Office 7F Date: <br /> Financial Services <br /> This instrument has been pre-audited irrtheffihhillePITquired by the Local Government Budget and Fiscal Control Act: <br /> (71p `.6°0. 6°"` 6/29/2017 <br /> Office of the Chief Financial Officer , ,__ ,., Date: <br /> Legal Services <br /> This agreement is approved as t c d suf iency: <br /> Office of the County Attorne Date: 7/2/2017 <br /> �.1 y 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 />