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OQDl - L <br /> ORANGE COUNTY DEPARTMENT USE ONLY <br /> Party/Vendor Name : David Sovero Party/Vendor Contact Person : Contact Phone : Party/Vendor <br /> Address : 300 Durant St, Apt . 303 City Chapel Hill State : NC Zip : 27517 Department : Aging Amount : $ 9 , 000 <br /> Purpose : Senior Center Instructor Budget Code(s) : 10430120 - 629000 Vendor # 57151 (N/A if new vendor) <br /> Vendor 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 /> Department Director ' s Signature Date : Zoe �9 <br /> Agreements for emergency servicesarrepaare not subject to t 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/sofhvare 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 /> Office of the Risk Management Officer !IL IIL5 Date : I � <br /> c► <br /> Financial Services <br /> This instrument has been pre- audited in the in er is u ' d by the Local Government Budget and Fiscal Control <br /> Act . t� <br /> Office of the Chief Financial Officer Date : / l <br /> Legal Services <br /> This agreement is approved as to legal fo n sufficiency : <br /> Office of the County Attorney Date : <br /> Clerk to the Board <br /> Received for record retention : <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion : smgersoll@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 />