HomeMy WebLinkAboutR 2019-380 Aging - Pamela Epperson instructir.doc DocuSign Envelope ID:424EE3A3-E7D8-45A2-99A0-38DBA4C653F2
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Pamela Epperson Party/Vendor Contact Person: Contact Phone: Party/Vendor
Address: 4611 Powder Mill Rd City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: $3,900
Purpose: Senior Center Instructor Budget Code(s): 10430120-629000 Vendor#65569 (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:
h DocuSigned by:
Department Director's Signature J tGt� _'bw Date:6/26/2019
Agreements for emergency services NE962❑1BF454FA.. ject 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 �US& (,6�6 Date:6/27/2019
7FDCF9176800498.
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: 6/27/2019
lr7NE5181ACC1409.
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney 4"o Date:6/27/2019
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