HomeMy WebLinkAboutR 2019-524 DEAPR - Nishith Trivedi martial arts instruction DocuSign Envelope ID: EAD61387-EOF3-42A1-B144-F5D636C155C1
ORANGE COUNTY-DEPARTMENT USE ONLY
Party/Vendor Name: Nishith Trivedi Party/Vendor Contact Person: Nishith Trivedi Contact Phone: 757-339-9090
Party/Vendor Address: 622 Childsberg Way City Hillsborough State: NC Zip: 27278 Department: DEAPR-
Recreation Amount: $3,000 Purpose: To instruct Mixed Martial Arts and Adult Self-Defense Budget Code(s):
10511020 630000 Vendor# 64927 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract
Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 7/24/2019 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:
CP.1
DocuSigned by:
a l goLa 7/30/2019
Department Director's Signature 1 CFA1D5o7A4s5.. Date:
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 sufficiency 'Docusigned_by:
. ' is,specifications,and requirements:
�USX �,DVln.fr��b 7/31/2019
Office of the Risk Management Officer 7FDCF9170900498. Datc:
Financial Services
This instrument has been pre-audited i DocuSigned by: the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer I 41.&1. Date:8/2/2019
7NE5181ACC1400-
Le2al Services
This agreement is approved as t DocuSigned by, iciency:
�bLW K6�tk�s 8/2/2019
Office of the County Attorney EAA3D33ED8AM65.. 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
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