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DocuSign Envelope ID:8C590A3B-6E9F-4346-9B92-8EE62290ADCE <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Martha Broda Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 1388 Manns Chapel Rd City Pittsboro State:NC Zip: 27312 Department: Aging Amount: $2,500 Purpose: <br /> Wellness Instructor Budget Code(s): 29430320-630000 Vendor# 58627 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date <br /> 07/01/2019 Approved by Board Yes❑Nor-1 Agenda 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 /> DocuSigned by::- '_ h DocuSigned by: <br /> Department Director's Signature �GU tu, �t�t,[.+'' Date: <br /> Agreements for emergency services B7E962D1BF454FA.. act to the above affirmation. If sere NE962D1BF454FA.. <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that was <br /> addressed: <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 /> DocuSigned by: <br /> Office of the Risk Management Officer a6 Cb�6 Date:6/24/2019 <br /> 7FDCF917e800498. <br /> Financial Services <br /> This instrument has been pre-audited in the manner reauired by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer Date: 6/24/2019 <br /> Er7NE5181ACCAH <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney 4"o Date: 6/24/2019 <br /> 4035CB8304CA4M <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 />