HomeMy WebLinkAboutR 2019-413 Health - Kevin Kirk DSME instructor DocuSign Envelope ID:56DO8A7F-OCDB-4460-8C66-9871979EC92C
ORANGE COUNTY-DEPARTMENT USE ONLY
Party/Vendor Name: Kevin Kirk Party/Vendor Contact Person: Kevin Kirk Contact Phone: 919-419-0171
Party/Vendor Address: 5311 Beaumont Drive City Durham State:NC Zip: 27707 Department: Health Amount: 600
Purpose: Group instruction for DSME program Budget Code(s): 10414020-630000-71405 Vendor# 34783 (N/A if
new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal
Amendment ❑ Effective Date 7-1-19 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:
AInG� S�_Wof 7/3/2019
Department Director's Signature 5F. Date:
3C16F2D09E344
Agreements for emergency services or repair are not subject 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 sufficient DocuSigned by: rds, specifications,and requirements:
aUS66 �,bVln.f,{�6 7/8/2019
Office of the Risk Management Office 7FDCF9176800498. Date:
Financial Services
This instrument has been pre-audited itIr7NE5181AMA00
DocuSigned by: the Local Government Budget and Fiscal Control Act:
4 � 7/8/2019
Office of the Chief Financial Officer . Date:
Legal Services
This agreement is approved as t DocuSigned by: {�
"k f' l�S(h 7/8/2019
Office of the County Attorney o79A4D525COF4FB. Date:
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