HomeMy WebLinkAboutR 2019-370 Aging - Janice Galloway wellness instructor DocuSign Envelope ID:3E3FB60E-F222-4DA0-BB07-8BE54CB4F178
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Janice Galloway Party/Vendor Contact Person: Contact Phone: Party/Vendor
Address: 6615 Glen Forest Dr City Chapel Hill State: NC Zip: 27517 Department: Aging Amount: $8,000
Purpose: Wellness Instructor Budget Code(s): 29430320-622000 Vendor#58613 (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:: '_
Department Director's Signature �A1n.ilt, +�uY' Date:6/21/2019
Agreements for emergency services NE962❑9BF454FA.. sect 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 aUsa LQ 6 Date: 6/22/2019
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 Date: 6/23/2019
704E5981ACC1409.
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney � � fay h Date: 6/24/2019
4035CB8304CA4Ae
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
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