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DocuSign Envelope ID:8BA82D31-6A78-46EA-B4A7-42D51 E297B86 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Linda Mansmann Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 8809 Farrington Mill Rd City Chapel Hill State: NC Zip: 27517 Department: Aging Amount: $5,000 <br /> Purpose: Wellness Instructor Budget Code(s): 29430320-622000 Vendor#64737 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ® Amendment ❑ Effective Date <br /> 8/20/17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> /^--DocuSigned by: <br /> 8/24/2017 <br /> Department Director's Signature J AGt- I t tA-V Date: <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 /> ni. 8/25/2017 <br /> Office of the Risk Management Officer (VIAL b Date: <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 /> i uocuSigned`by: <br /> Office of the Chief Financial Officer <br /> 8/25/2017 <br /> —7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> p--DocuSigneend,,by��:♦�-�� <br /> Office of the County Attorney <br /> u�A. hark, 1SG6 Date: 8/25/2017 <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 />