HomeMy WebLinkAboutR 2016-369-E Aging - Nancy Alton for wellness instructor DocuSign Envelope ID: D0743AF4-A904-420B-8ADC-488A6EF131AC
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Nancy Alton Party/Vendor Contact Person: Contact Phone: Party/Vendor
Address: 3917 Marklyn PI City Hillsborough State: NC Zip: 27278 Department: Aging Amount: $3,000 Purpose:
Wellness Instructor Budget Code(s): 10430120-630000-71085 Vendor# 58145 (N/A if new vendor) Vendor is a
BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date
July 15,2016 Approved by Board Yes❑No® Agenda Date:
This agreement is approved as to technical form and content:
Docu5igned by:
7/13/2016
Department Director's Signature � '�� Date:
67E962D18F454FA...
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:
Docu5igned by:
Office of the Risk Management Officer pllS. (,6nAA 11i1 6 Date: 7/14/2016
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in the Wan age erdevmred by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer (� `�°'�"��°'v Date: 7/14/2016
7D4E5181ACC1409...
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney In,_ Date: 7/18/2016
4035CE8304CA4A9...
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 6/16 5