HomeMy WebLinkAboutR 2015-112-E Aging - Jan Gittelman for clogging classes DocuSign Envelope ID:2744CF92-DCCB-4858-8AD8-1B429F1A1590
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Jan Gittelman Party/Vendor Contact Person: Contact Phone: Party/Vendor
Address: 2406 Buck Quarter Farm Rd City Hillsborough State:NC Zip: 27278 Department:Aging Amount: $990.00
Purpose: clogging classes Budget Code(s): 10430120-629000 Vendor 4 N/A (N/A if new vendor) Vendor is a
BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date
0111512015 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to technical form and content:
DocuSigned by:
Department Director's Signature �AW«- bur Date:
1/10/2015
B7E962D1BF454FA...
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficiency of insurance standards,specifications,and requirements:
--DocuSigned�"by: 11LL
Office of the Risk Management Officer a�lSa (,bnL&b Date: 1/12/2015
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in the mape�rigreq .Mired
by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer F _)_ V�Rti Date: 1/15/2015
2F982EC44=444...
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney Date: 1/15/2015
4085CB8304CA4A9...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 10/14 4