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DocuSign Envelope ID:4F5BB1 FB-3D07-4404-943F-42364864E179 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Martha Broda Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 1388 Maims Chapel Road City Pittsboro State: NC Zip: 27312 Department: Aging Amount: $2,000 <br /> Purpose: Wellness Instructor Budget Code(s): 29430320-630000 Vendor#58627 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ No Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date <br /> 7/01/17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to technirgal uSi fagned rm gy:nd content: <br /> oc <br /> �611AA t, �i1LL4 7/20/2017 <br /> Department Director's Signature` Date: <br /> B7E962D1 BF454FA... <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 /> 'll <br /> ,tl6 <br /> Office of the Risk Management Officer aMtS& Cbvwc Date: 7/20/2017 <br /> t 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 0.o Date: 7/20/2017 <br /> '-7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legobr1 ai�d sufficiency: <br /> ocu igne y: <br /> a ov oit, -Nto 7/24/2017 <br /> Office of the County Attorney Date: <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 />