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DocuSign Envelope ID:D49A8E11-5233-458F-865E-DEB58D7F1091 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Kathleen Hammon Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 1102 E Franklin St City Chaoel Hill State: NC Zip: 27514 Department: Aging Amount: $3,000 Purpose: <br /> Wellness Instructor Budget Code(s): 10430120-770105 Vendor#56311 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 7/01/17 <br /> Approved by Board Yes' No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> -- <br /> /- ocuSigned y: <br /> 7/12/2017 <br /> Department Director's Signature J10-- 1-11(1-r 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 /> Office of the Risk Management Officer aMtS& rbi l&th Date: 7/13/2017 <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 /> Office of the Chief Financial Officer Date: <br /> 7/13/2017 <br /> —7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> p--DocuSigneend,,by��:♦�-�� <br /> Office of the County Attorney <br /> 0.t,u, L hark, 1 Scb Date: 7/13/2017 <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 />