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ORANGE COUNTY DEPARTMENT USE ONLY <br /> Party/Vendor Name : Dan Eubanks Party/Vendor Contact Person: Contact Phone : Party/Vendor <br /> Address : 2300 Judah Benjamin Ct City Hillsborough State : NC Zip : 27278 Department: Aging Amount : $4 , 800 <br /> Purpose : Senior Center Instructor Budget Code(s) : 1043012M29000 Vendor # 62349 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes [] No ❑ Contract Type : (Check one) New ❑ Renewal ® Amendment ❑ Effective <br /> Date 07/01 /2019 Approved by Board Yes❑ No❑ Agenda Date : <br /> This agreement is approved as to technical forin 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 /> let <br /> Department Director ' s Signature Date : <br /> Agreements for emergency services � r repair are not subject to e above affirmation. If services related to this <br /> agreement have already begun or ben completed please briefly describe the nature of the emergency condition that was <br /> addressed : <br /> Information Technologies <br /> (Applicable only to harditvare/softtii are 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. Date : j T <br /> inane icesThis instrument has been pre-audited in the m e Local Government Budget an Fis al Control Act: <br /> Office of the Chief Financial Officer Date : �3 1es <br /> This agreement is approved as to legal form a d s ciency ; G / <br /> Office of the County Attorney Date : V b l <br /> Clerk to the Board <br /> Received for record retention : <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: smgersoll@ora-ngecou-ntyne . gov <br /> orangecountyne . gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts : <br /> Office of the Cleric to the Board Date ; rfq <br /> Revised 12/ 18 4 <br />