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Esbfp 070120 v1 <br />ORANGE COUNTY EMERGENCY LOAN PROGRAM—INTERNAL USE ONLY <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Dentinger Chiropractic and Wellness, PLLC Party/Vendor Contact Person: <br />Catherine Niezgoda Contact Phone: 919-307-9610 Party/Vendor Address: 901 WILLOW <br />DRIVE, STE 1 City: Chapel Hill State: NC Zip: 27514 Department: Economic Development <br />Amount: $5,000 Purpose: Emergency Small Business Funding Program Budget Code(s): <br />34600020-900047 Vendor # 66434 (N/A if new vendor) <br /> <br />This agreement is approved as to technical form and content and I as Department Director <br />affirmatively state work on this project has not been initiated prior to execution of the agreement: <br /> <br /> <br />Department Director’s Signature _________________________________ Date: _________ <br /> <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and <br />Fiscal Control Act: <br /> <br />Office of the Chief Financial Officer _______________________________ Date: _________ <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney _____________________________________ Date: _________ <br /> <br /> <br />Clerk to the Board <br /> <br />Received for record retention: <br />All DocuSign contracts must be copied to Sherri Ingersoll upon completion: <br />singersoll@orangecountync.gov <br />The following signature block is for hard copies only and is not required for DocuSign contracts: <br /> <br />Office of the Clerk to the Board ___________________________________ Date:__________ <br /> <br /> <br /> <br />DocuSign Envelope ID: E66E1F1B-CDCD-4936-AE3A-0850B81A7D89 <br />7/8/2020 <br />7/8/2020 <br />7/8/2020