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DocuSign Envelope ID: 1546E635-90E6-47DB-A413-373CA8A49D89 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Nina Maier Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: <br /> 3302 Pearson Rd City Hurdle Mills State: NC Zip: 27541 Department: Aging Amount: $3,500 Purpose: Wellness <br /> Instructor Budget Code(s): 29430320-630000 Vendor#51178 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 07/01/2019 <br /> 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 on <br /> this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by::- '_ 7/17/2019 <br /> Department Director's Signature �aan.iGt, �+�b_r Date: <br /> Agreements for emergency services of UE962D1BF454FA.. A 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 /> sa LQ 6 <br /> a ( , <br /> Office of the Risk Management Officer U Date: 7/18/2019 <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 /> 7/19/2019 <br /> Office of the Chief Financial Officer lr7NE5181ACC1409 <br /> s��rx.wra Date: <br /> . <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney ��,O Date: <br /> 7/19/2019 <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 4 <br />