HomeMy WebLinkAboutR 2016-336-E Aging - Toni Shaw for wellness instructor DocuSign Envelope ID:F5F38958-9442-4472-A709-F5D97CE67E1A
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Toni Shaw Party/Vendor Contact Person: Contact Phone: Party/Vendor Address:
1301 Deerfield Trace City Mebane State: NC Zip: 27302 Department: Aging Amount: $3,000 Purpose: Wellness
Instructor Budget Code(s): 29430320-630000 Vendor#61838 (N/A if new vendor) Vendor is a BOCC consultant?
Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date July 1, 2016
Approved by Board Yes❑No® Agenda Date:
This agreement is approved as to technigal form and content:
ocuSigned by:
Department Director's Signatur
rj�t& -Ar�'r Date: 6/28/2016
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:
by:
FDocuSigned
liSa ,,__ ••llll 6/29/2016
Office of the Risk Management Officer vvullb Date:
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
DocuSigned by.
Office of the Chief Financial Officer 16.&. Date:7/5/2016
7D4E5181ACC1409...
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney Date: 7/6/2016
4035CB8304CA4A9...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync•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 6/16 5