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ao I q - �`fS <br />ORANGE COUNTY - DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: William Meyers Party /Vendor Contact Person: Contact Phone: Party/Vendor <br />Address: 1204 Little Creek Rd City Durham State: NC Zip: 27713 Department: Aging Amount: $500 Purpose: <br />wellness instructor Budget Code(s): 29430320 - 630000 Vendor # 56366 (N /A if new vendor) Vendor is a BOC <br />consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date <br />7/01/2018 Approved by Board Yes❑ Non Agenda Date: <br />This agreement is approved as to technical form and content: <br />Department Director's Signature Date: Y J -le <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 <br />Risk Management <br />Date: <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />Office of the Risk Management Officer a-zl- <br />- Date: <br />- U <br />Financial Services <br />This instrument has been pre- audited in the ne r ired by the Local Government Budget and Fiscal Control Act: <br />Office of the Chief Financial Officer Date: 8 <br />Legal Services <br />This agreement is approved as to legal forip an ficiency: <br />Office of the County Attorney Date:������ <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersoll upon completion: sin erg_ soil a,orangecountync.g ov <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: 04i �f <br />Revised 10/17 5 <br />