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ORANGE COUNTY - DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: Kathleen Hammon Party /Vendor Contact Person: Contact Phone: Party/Vendor <br />Address: 1102 E Franklin St City Chapel Hill State: NC Zip: 27514 Depart ent: Aging Amount: $3,000 Purpose: <br />wellness instructor Budget Code(s): 10430120 - 770105 & 29430320 -63000 Vendor # 56311 (N /A if new vendor) <br />Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) eW enewal ® Amendment ❑ <br />Effective Date 7/01/18 Approved by Board Yes❑ No❑ Agenda Date: IWI & <br />This agreement is approved as to technical form and content: <br />Department Director's Signature Date: S-120-101V <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: <br />g <br />Nii ervices <br />This instrument has been pre - audited in the ne the Local Government Budget and Fiscal Control Act:. <br />Office of the Chief Financial Officer Date: S Z CS <br />Legal Services <br />This agreement is approved as to legal form a d ficiency: <br />Office of the County Attorney Date: d <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersoll upon completion: sin eg rsoll@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 10/17 (Mgr appry 5k 6/18) 4 <br />