HomeMy WebLinkAboutR 2015-299-E Health - Kevin Kirk dba Functional Fitness, LLC for group instruction for DSME program DocuSign Envelope ID: 325199DB-D82D-4FOE-841D-AA2307F7F5AA
ORANGE COUNTY—DEPARTMENT USE ONLY
Deuartment
Party/Vendor Name: Kevin Kirk dba Functional Fitness, LLC Party/Vendor Contact Person: Kevin Kirk Contact
Phone: 919-419-0171 Party/Vendor Address: 605 Eastowne Dr., Suite C City Chapel Hill State: NC Zip: 27514
Department: Personal Health Amount: $600 Purpose: Group instruciton for DSME program. Budget Code(s):
10414020-630000-71405 Vendor 4 62663 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑
Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7/1/2015 Approved by Board
Yes❑No❑ Agenda Date:
This agreement is approved as to to f L , f?i�?AufiqrFAend content:
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Department Director's Signature E-e99GPG Date: 6/24/2015
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 sufficienc �mxwtfjoMandards,specifications,and requirements:
ausa, (hm,&b 6/29/2015
Office of the Risk Management Officer FBSF,)47-6899449 Date:
Financial Services
This instrument has been pre-audited i �s ��squired by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer o�F�e Date: 6/29/2015
Legal Services
This agreement is approved as t �afimaaod sufficiency:
Office of the County Attorneys Date: 6/29/2015
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 5