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DocuSign Envelope ID:7DD7F4D3-CEEF-46E3-9328-FF7AE627E195 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Elderfit In Home Rehab Party/Vendor Contact Person: Vicki Tilley Contact Phone: <br /> Party/Vendor Address: 2002 Bartlett Drive City Hillsborough State: NC Zip: 27278 Department: Aging Amount: <br /> 3500 Purpose: Wellness Instructor Budget Code(s): 29430320-630000 & 10430120-770105 Vendor# 66852 (N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 11/20/2020 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 /> hh DocuSigned by: <br /> Department Director's Signature Date: 11/19/2020 <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 iuugWwp,,§:tandards,specifications,and requirements: <br /> Office of the Risk Management Officer &A, Ch ucTTb Date: 11/19/2020 <br /> Financial Services <br /> This instrument has been pre-audited in&WmftW#vquired by the Local Government Budget and Fiscal Control Act: <br /> +� � <br /> Office of the Chief Financial Officer Date:11/23/2020 <br /> Legal Services <br /> This agreement is approved as to 1 i�au'c}nw#v6rsufficiency: <br /> Office of the County Attorney Date: 11/25/2020 <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 />