HomeMy WebLinkAboutR 2017-191-E Aging - Michelle Rogers, Inc. for wellness instructor DocuSign Envelope ID:451855F0-5EC3-471 B-A519-9B26FC68FF69
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Michelle Rogers, Inc. Party/Vendor Contact Person: Contact Phone:
Party/Vendor Address: 210 Virginia Lee Lane City Efland State: NC Zip: 27243 Department: Aging Amount:
$800.00 Purpose: Wellness Instructor Budget Code(s): 10430120-770105 Vendor # 64462 (N/A if new vendor)
Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑
Effective Date 5/01/17 Approved by Board Yes No Agenda Date:
This agreement is approved as to technicalDformnan content:
ocu Department Director's Signature
a�,tu 1-Y,G ' Date: 5/24/2017
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:
r----DocuSigned by:
q � 5/25/2017
Office of the Risk Management Officer ausa rtAk116 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 /25/2017
�a� �°".�a°'z Date:ate:
-7D4E5181 ACC1409...
Legal Services
This agreement is approved as to legal form and sufficiency:
r--DocuSigneed"byy:'hark,Attorney ate, VVW&Yk, -I-.SCb 5/25/2017
Office of the Coun Attorne Date:
`—079A4D525C0F4FB...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.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 2/17 5