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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: Universes of North Carolina at Chapel Hill Party/Vendor Contact Person: Kevin Castle ' <br /> Contact Phone: Party/Vendor Address: 3114 Bondurant Hall, CB#7120 City Chapel Hill State: NC Zip: <br /> 27599 Department:Aging Amount:$j,0Q0 Purpose: Fitness Studio Screening Budget Code(s):29430320-630000 <br /> Vendor# 10419 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check one) <br /> New ❑ Renewal ® Amendment ❑ Effective Date 5/01/17 Approved by Board Yes❑ No❑ Agenda <br /> Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: 7.4 <br /> Information Technolozies <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 Risk Management Date:1� <br /> Finan ' I Se es <br /> This instrument has been pre-audited in the nn re it by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: Q <br /> Lesal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney A'T/L( � lr--W-u _ Date: ?31111 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised 2/17 <br />