HomeMy WebLinkAboutR 2019-366 Aging - Martha Broda wellness instructor DocuSign Envelope ID:8C590A3B-6E9F-4346-9B92-8EE62290ADCE
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Martha Broda Party/Vendor Contact Person: Contact Phone: Party/Vendor
Address: 1388 Manns Chapel Rd City Pittsboro State:NC Zip: 27312 Department: Aging Amount: $2,500 Purpose:
Wellness Instructor Budget Code(s): 29430320-630000 Vendor# 58627 (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date
07/01/2019 Approved by Board Yes❑Nor-1 Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work on
this project has not been initiated prior to execution of the agreement:
DocuSigned by::- '_ h DocuSigned by:
Department Director's Signature �GU tu, �t�t,[.+'' Date:
Agreements for emergency services B7E962D1BF454FA.. act to the above affirmation. If sere NE962D1BF454FA..
agreement have already begun or been completed please briefly describe the nature of the emergency condition that was
addressed:
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:
DocuSigned by:
Office of the Risk Management Officer a6 Cb�6 Date:6/24/2019
7FDCF917e800498.
Financial Services
This instrument has been pre-audited in the manner reauired by the Local Government Budget and Fiscal Control Act:
DocuSigned by:
Office of the Chief Financial Officer Date: 6/24/2019
Er7NE5181ACCAH
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney 4"o Date: 6/24/2019
4035CB8304CA4M
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@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 12/18 4