HomeMy WebLinkAboutR 2019-367 Aging - Toni Shaw wellness instructor DocuSign Envelope ID: EOB46BO9-A38F-4D11-9D82-B9AD1A524F7A
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name:
Toni Shaw Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 3049 Bermuda Bay
Lane, #101 City Mebane State: NC Zip: 27302 Department: Aging Amount: $2,000 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 07/01/2019 Approved by
Board Yes❑No❑ 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: 6/23/2019
Department Director's Signature ciUE962DI
OAi(rt, �+�b_r Date:
Agreements for emergency servicesBF454FA.. _act to the above affirmation. If services related to this
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 QU56 L.Qw 6 Date:6/24/2019
7FDCF9176900498.
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 ( s�gx.waa Date: 6/24/2019
7NE5181ACC1409.
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney ��,�� f� 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@orangecountyne.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