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DocuSign Envelope ID:ACBA2531-E059-4651-9BC6-691B99462895 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Louise Keefer Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 909 B ShadyLawn Road Ext City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: $1,000 <br /> Purpose: Wellness Instructor Budget Code(s): 10430120-770105 Vendor#66023 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date <br /> 03/01/2020 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 on <br /> this project has not been initiated prior to execution of the agreement: <br /> h DocuSigned by: <br /> �AatidGL Department Director's Signature -�b.lr Date: 2/26/2020 <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 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 ��pgSystandards,specifications,and requirements: <br /> / / <br /> Office of the Risk Management Officer Q�Sa V�T b 27 Date: 2 2020 <br /> Financial Services <br /> This instrument has been pre-audited i > M#4)equired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer 0 Date:2/27/2020 <br /> Legal Services <br /> This agreement is approved as to(legabformvowl sufficiency: <br /> Office of the County Attorney 'F Date: 2/27/2020 <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 />