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DocuSign Envelope ID:80CDDOE6-7F74-4289-9C39-8D8E11AOD8B6 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Shu Hwa Fan Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 120 Virginia Drive City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: $1,200 Purpose: <br /> Wellness Instructor Budget Code(s): 10430120-770105 Vendor#64655 (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 technicalDfghvgdycontent: <br /> Department Director's Signature Jai�u' � Date: 7/17/2017 <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 aMMS& 661(Vu'll Date: 7/17/2017 <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 /> 7/17/2017 <br /> Office of the Chief Financial Officer rI Date:-7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> p--DocuSigned by: <br /> Office of the County Attorney ate, hark, 1 sco Date: 7/17/2017 <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 />