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DocuSign Envelope ID:CF846751-E6B1-4B2E-BD71-5008930BB362 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Jennifer Ginsburg Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 215 Boulder Bluff Trail City Chapel Hill State: NC Zip: 27516 Department: Aging Amount: $3,000 <br /> Purpose: Wellness Instructor Budget Code(s): 29430320-622000 Vendor#65692 (N/A if new vendor) Vendor is a <br /> BOCC 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:: '_ <br /> Department Director's Signature ,�G tu, �t�t,[.+'' Date: 6/26/2019 <br /> Agreements for emergency services UE902D16F454FA.. Ct 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 QUSA cbm_&6 Date:6/27/2019 <br /> 7FDCF9176800498. <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Office (I A Date: 6/27/2019 <br /> 7 NE5181 ACC 1409. <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ocusigned by: <br /> Office of the County AttorneyC_� Date: 6/27/2019 <br /> 035C68304CA4M <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 />