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oLo18 76 3 <br />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 Z' :27278 Department: Agin Amount: <br />$1,200 Purpose: wellness instructor Budget Code(s): 10430120 - 770105 dor # 58051 (N /A if new vendor) <br />Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check on R newal ® Amendment ❑ <br />Effective Date 7/01/2018 Approved by Board Yes❑ No❑ Agenda Dat . <br />This agreement is approved as to technical form and content: <br />Department Director's Signature t Date: <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 Date: I Ir r <br />Einar 4vices <br />This instrument has been pre - audited in the man e re i e y the Local Government Budget and Fiscal Control Act: <br />Office of the Chief Financial Officer Date: ezy y <br />Lej4al Services <br />This agreement is approved as to legal fo sufficiency: <br />Office of the County Attorney Date: 1 Zz <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersoll upon completion: sinaersoll e,oran eg countync.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 <br />Revised 10/17 5 <br />Date: <br />