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DocuSign Envelope ID:C733D067-EAD3-48E9-A1 F0-3E430A56A0B3 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Stephanie Yost Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 7700 Amesbury Dr City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: $5,000 Purpose: <br /> Wellness Instructor Budget Code(s): 29430320-630000 Vendor#34784 (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 /> /^--DocuSigned by: <br /> Department Director's Signature jouia, t'illtr Date: 7/12/2017 <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_by: <br /> Office of the Risk Management Officer aMtS& 661(Vu'U{ 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 rIAA61 Ana, am Date: 7/13/2017 <br /> ' —7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> �/ ocuSigneend,,by: <br /> ♦�-�� <br /> U bUA L ova ark- fibSCb 7/13/2017 <br /> Office of the County Attorne Date: <br /> 079A4D525COF4FB... <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 />