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DocuSign Envelope ID:2615EA1B-DB4D-4BB1-BC27-8E1D55FDF344 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Connie Winstead Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 3000 Montgomery St City Durham State:NC Zip: 27705 Department:Aging Amount: $6,000 Purpose: <br /> Wellness Instructor Budget Code(s): 29430320-630000 Vendor # 57329 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective <br /> Date 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 <br /> on this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by:: <br /> D b_r6/27/2019 <br /> Department Director's Signature_ B7E962❑1BF454FA.. Date: <br /> Agreements for emergency services or repair are not subject 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 r W Signed by: ' 's,specifications,and requirements: <br /> Office of the Risk Management Officer �U$6. �,bVln.t,{�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 <br /> Act: DocuSigned by: <br /> 6/29/2019 <br /> Office of the Chief Financial Officer[7D4E�1a1ACCAN. Date: <br /> Legal Services <br /> This agreement is approved as to DocuSigned by: ey: <br /> 7/1/2019 <br /> Office of the County Attorney Date: <br /> 4035C68304CA4M <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 />