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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Seine Wolfe Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 909 Palmers Grove Church Rd City Hillsborough State: NC Zily. 27278 Department: Aging Amount: <br /> $2,000 Purpose: Wellness Instructor Budget Code(s): 10430 20-630120 ndor # 58051 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No[:] Contract Type: (Check one)[Mw Renewal M Amendment E]Effective Date 7/01/17 Approved by Board Yes❑NoM Agenda Date: Ht <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: X-l" <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 64-- k(. Date: 17 <br /> Fin cial Services <br /> This instrument has been pre-audited in the �er P�uired the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: <br /> "77 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency:/ <br /> Office of the County Attorney f '��,t ,`�"l.Gt,G. / t tr— Date: a207 1 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd norangecountync. ov <br /> The following signature block is for hard copies only s re red for Docusign contracts: .� <br /> 1 <br /> Office of the Clerk to the Board Date: < J_--/J/ <br /> ^� <br /> Revised 2/17 5 <br />