Orange County NC Website
Browse       Search
DocuSign Envelope ID: EOB46BO9-A38F-4D11-9D82-B9AD1A524F7A <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: <br /> Toni Shaw Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 3049 Bermuda Bay <br /> Lane, #101 City Mebane State: NC Zip: 27302 Department: Aging Amount: $2,000 Purpose: Wellness Instructor <br /> Budget Code(s): 29430320-630000 Vendor#61838 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ <br /> No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 07/01/2019 Approved by <br /> Board Yes❑No❑ 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: 6/23/2019 <br /> Department Director's Signature ciUE962DI <br /> OAi(rt, �+�b_r Date: <br /> Agreements for emergency servicesBF454FA.. _act to the above affirmation. If services related to this <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 QU56 L.Qw 6 Date:6/24/2019 <br /> 7FDCF9176900498. <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer ( s�gx.waa Date: 6/24/2019 <br /> 7NE5181ACC1409. <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney ��,�� f� Date: <br /> 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@orangecountyne.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 />