Orange County NC Website
Browse       Search
DocuSign Envelope ID:3E3FB60E-F222-4DA0-BB07-8BE54CB4F178 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Janice Galloway Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 6615 Glen Forest Dr City Chapel Hill State: NC Zip: 27517 Department: Aging Amount: $8,000 <br /> Purpose: Wellness Instructor Budget Code(s): 29430320-622000 Vendor#58613 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ <br /> Effective Date 07/01/2019 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by:: '_ <br /> Department Director's Signature �A1n.ilt, +�uY' Date:6/21/2019 <br /> Agreements for emergency services NE962❑9BF454FA.. sect 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 <br /> was 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 <br /> _by: <br /> . <br /> Office of the Risk Management Officer aUsa LQ 6 Date: 6/22/2019 <br /> 7FDCF9176800498. <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer Date: 6/23/2019 <br /> 704E5981ACC1409. <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney � � fay h Date: 6/24/2019 <br /> 4035CB8304CA4Ae <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 <br /> 8 <br />