HomeMy WebLinkAboutR 2016-171-E Aging - Nathaniel Shapiro for fitness studio DocuSign Envelope ID: CE03F77E-2613-496A-9C6E-F11685DF6CDA
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Nathaniel Shapiro Party/Vendor Contact Person: Contact Phone: Party/Vendor
Address: 2701 Homestead Rd, Apt #113 City Chapel Hill State: NC Zip: 27516 Department: Aging Amount:
$3,000.00 Purpose: Fitness Studio Budget Code(s): 10430120-630000-71085 Vendor# 63616 (N/A if new vendor)
Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑
Effective Date 02/29/16 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to technical forth and content:
Docu5igned by:
Department Director's Signatur ,WAA*a. JA' W Date: 2/23/2016
67E962D1BF454FA...
Information Technolosies
(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:
/ ""by:��1111
Office of the Risk Management Officer
FDocuSigned
uSA. ('6M c& Date: 2/24/2016
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in th gnmq"ired by the Local Government Budget and Fiscal Control Act:
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Office of the Chief Financial Officer rl� Date: 2/26/2016
7D4E 181ACC1409...
Legal Services
This agreement is approved as to 1 �,k�t, sufficiency:
Office of the County Attorney � .- Date: 2/29/2016
4035CB8304CA4A9...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.gov
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 1/16 4