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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name : Dan Eubanks Party/Vendor Contact Person : Contact Phone : Party/Vendor <br /> Address : 2300 Judah Benjamin Ct . City l4illsborough State : NC Zip : 27278 Department : Aging Amount : $ 2 , 000 <br /> Purpose : class instructor Budget Code ( s*60430120mw629000 Vendor 62349 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ No ❑ Contre : ( Check one ) New Renewal ® Amendment ❑ Effective Date <br /> 3 /01 / 19 Approved by Board Yes ❑ Nogenda Date : <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initiated prior to execution of the agreement : <br /> Department Director ' s Signature Z2 Date : Y AL /7 <br /> Agreements for emergency services r re it are not subject to th above affirmation . If services related to this <br /> agreement have already begun or be completed please briefly describe the nature of the emergency condition that was <br /> addressed : <br /> Information Technologies <br /> (Applicable only to hardN) are/sofhvare 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_ 0000t�- � t�..�^- -�� Date : 31 7 cl <br /> Finanicial ,Services <br /> This instrument has been pre - audited in the m er r it by the Local Government Budget and Fiscal Control Act : <br /> Office of the Chief Financial Officer Date : 517Z51119 <br /> Legal Services <br /> This agreement is approved as to legal f rm nd sufficiency : <br /> Office of the County Attorney Date : 3 � � <br /> Clerk to the Board <br /> Received for record retention : <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion : singersoll@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 12/ 18 4 <br />