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aoi 9 � � 33 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name : William Meyers Party/Vendor Contact Person : Contact Phone : Party/Vendor <br /> Address : 1204 Little Creek Rd City Durham State : NC Zip : 27713 Department $ Aging Amount : $ 2 , 000 Purpose : <br /> Wellness Instructor Budget Code (s) : 29430320 - 630000 Vendor # 56366 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No ❑ Contract Type : (Check one) New ❑ Renewal ® Amendment ❑ Effective Date <br /> 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 on <br /> this project has not been initiated prior to execution of the agreement . <br /> Department Director ' s Signature Date $ <br /> Agreements for emergency services o ep rr are not subject t e above affirmation . If services related to this <br /> agreement have already begun or be mpleted please briefly describe the nature of the emergency condition that was <br /> addressed : <br /> Information Technolol4ies <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 /> Office of the Risk Management Officer ) Date : <br /> WingCifigilvices <br /> This instrument has been pre- audited in the manhe Local Government Budget and F ' scal Control Act : <br /> r / f <br /> Office of the Chief Financial Officer Date : <br /> Lel4aI Services <br /> This agreement is approved as to legal f and sufficiency : <br /> Office of the County Attorney Date : 1, j � 1 <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 Cleric to the Board Date ; <br /> Revised 12/ 18 4 <br />