HomeMy WebLinkAboutR 2020-012 Aging - Polly Riseling Senior Center instructor ORANGE COUNT Y' DElPARTM ETA` T USE ONLY
Party/Vendor Name : Polly T Riseling Party/Vendor Contact Person : Contact Phone : Party/Vendor
Address : 815 Hi lg lway 70A E , unit 219 City Hillsborough State : NC Zip : 27278 Department : Aging Amount :
$ 1000 Purpose : Senior Center Instructor Budget Code (s) : 1043012M29000 Vendor # 65927 (N/A if new vendor)
Vendor is a BOCC consultant? Yes ❑ No ❑ Contract Type : (Check one) New ® Renewal ❑ Amendment ❑
Effective Date 01 /01 /2020 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 ,
Department Director ' s Signature Date . /-
Agreements for emergency services or air e not subject to the ove affirmation . If services related to this
agreement have already begun or been ore
ted please briefly describe the nature of the emergency condition that was
addressed . i
l
Information Technologies 1
(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 aor
greement is approved for sufficiency of insurance standards , specifications , and requirements .
Office of the Rise Management Officer Date : i 3 2-u
Mrd
Services
v� This instrument has been pre-audited in the m by the Local Government Budget and Fiscal Control Act :
Office of the Chief Financial Officer Date :
Legal Services
This agreement is approved as to legal fo an suffi ' e eye
Office of the County Attorney Date : ZbZl�
Clerk to the Board
Received for record retention :
All Docusign contracts must be copied to Sherri Ingersoll upon completion : smgersoll@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 41P Date : VZO zG
Revised 12/ 18 4