HomeMy WebLinkAboutR 2019-614 Aging - Dan Eubanks senior center instructor ORANGE COUNTY DEPARTMENT USE ONLY
Party/Vendor Name : Dan Eubanks Party/Vendor Contact Person: Contact Phone : Party/Vendor
Address : 2300 Judah Benjamin Ct City Hillsborough State : NC Zip : 27278 Department: Aging Amount : $4 , 800
Purpose : Senior Center Instructor Budget Code(s) : 1043012M29000 Vendor # 62349 (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 forin and content and I as Department Director affirmatively state work on
this project has not been initiated prior to execution of the agreement :
let
Department Director ' s Signature Date :
Agreements for emergency services � r repair are not subject to e above affirmation. If services related to this
agreement have already begun or ben completed please briefly describe the nature of the emergency condition that was
addressed :
Information Technologies
(Applicable only to harditvare/softtii are 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 :
Office of the Risk Management Officer. Date : j T
inane icesThis instrument has been pre-audited in the m e Local Government Budget an Fis al Control Act:
Office of the Chief Financial Officer Date : �3 1es
This agreement is approved as to legal form a d s ciency ; G /
Office of the County Attorney Date : V b l
Clerk to the Board
Received for record retention :
All Docusign contracts must be copied to Sherri Ingersoll upon completion: smgersoll@ora-ngecou-ntyne . gov
orangecountyne . gov
The following signature block is for hard copies only and is not required for Docusign contracts :
Office of the Cleric to the Board Date ; rfq
Revised 12/ 18 4