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ORANGE COUNTY—DEPARTMENT USE ONLY 011u, ' <br /> Department <br /> Party/Vendor Name: William Mew Party/Vendor Contact Person: Contact Phone: Party/ <br /> Address: 1204 Little Creek Rd City Durham State: NC p: 27713 Department: Aging Amount: $1,500 ose: <br /> Wellness Instructor Budget Code(s): 29430320-630000�ndor# 56366 (N/A if new vendor) Vendor is a BOCC IL% <br /> consultant? Yes❑Non 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 /> Department Director's Signature Date: <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 /> Office of the Risk Management Officer zC� 0 d t d Date: 7 <br /> Urequid rvices <br /> This instrument has been pre-audited in the man the Lo cal Government Budget Fi cal Control Act: <br /> Office of the Chief Financial Officer Date: 7/177.117 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney (Aw(,�1!& `fnr Date:A 1 i 11 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecountync.gov <br /> The following signature block is for hard ie and i not required for Docusign contracts <br /> Office of the Clerk to the Board Date: i1 <br /> Revised 2/17 5 <br />