R 2017-286-E Aging - Janice Galloway for wellness instructor

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DocuSign Envelope ID:AEC896C7-7694-4887-A4FE-8A80ADE254E5 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Janice Galloway Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 6615 Glen Forest Dr City Chapel Hill State: NC Zip: 27517 Department: Aging Amount: $6,000 Purpose: Wellness Instructor Budget Code(s): 29430320-622000 Vendor#58613 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 7/01/17 Approved by Board Yes' No Agenda Date: This agreement is approved as to technical form and content: /^--DocuSigned by: Department Director's Signature ja kAa- � t V Date: 7/10/2017 B7E962D1BF454FA... Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: r---DocuSigned by: aLtS& Cb b 7/11/2017 Office of the Risk Management Officer Date: 7FDCF9176800498... Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: ,----DocuSigned Office of the Chief Financial Officer /11/2017 �a� °". a°'z Date:ate: -7D4E5181 ACC1409... Legal Services This agreement is approved as to legal form and sufficiency: p--DocuSigned by: Office of the County Attorney ate, hark, 1 sco Date: 7/11/2017 `—079A4D525C0F4FB... Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 2/17 5