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DocuSign Envelope ID:ED2CCF62-5EB3-44E8-BDBF-108FCDEA983A <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Jennifer Sugg Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: PO Box 272 City Bynum State: NC Zip: 27228 Department: Aging Amount: $2,500 Purpose: Wellness <br /> Instructor Budget Code(s): 29430320-622000 Vendor#63091 (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 /> 7/2/2017 <br /> Department Director's Signature j LUtA L- 1-11k4'' Date: <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 /> 'll <br /> Office of the Risk Management Officer <br /> a�1S& rbvvutl6 Date: 7/3/2017 <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 /> , ---DocuSigned by: <br /> 7/3/2017 <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--DocuSigneend,,by��:♦�-�.� <br /> County Attorney U.bUA.t, hark,, -Nto 7/3/2017 <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 />