HomeMy WebLinkAboutR 2016-339-E Health - Kevin Kirk dba Functional Fitness, LLC for group instruction for DSME program DocuSign Envelope ID:D8CCE739-BC40-475F-83D5-EB8CB65D9E58
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
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: Health Amount: $600 Purpose: Group instruciton for DSME program. Budget Code(s): 10414020-
630000-71405 Vendor#62663 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type:
(Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7/1/2016 Approved by Board Yes❑ No❑
Agenda Date:
This agreement is approved as to to 1 T1 'AY1d content:
�- 7/6/2016
Department Director's SignatureE FGGB545E Date:
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 m r9Haaeystandards, specifications, and requirements:
Q�ISa C,bvwc,116 7/6/2016
Office of the Risk Management Officer eeF�hn Date:
Financial Services
This instrument has been pre-audited iryttwWfiYAWW&Yquired by the Local Government Budget and Fiscal Control Act:
p ° `"` 7/6/2016
Office of the Chief Financial Officer ���eaFc, os Date:
Legal Services
This agreement is approved as t eg°a4`M `'ft sufficiency:
��
Office of the County Attorney -� Date: 7/6/2016
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(a�oran.eg count, nc.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 4