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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> NOT A CONTRACT EXHIBIT OR ATTACHMENT <br /> Department <br /> Party/Vendor Name: Lara Balian Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: <br /> 2921 Kingston Ave City Durham State: NC Zip: 27704 Department: Aging Amount: $6,250.00 Purpose: MAP <br /> Budget Code(s): 10430020-630120 Vendor# 61905 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ <br /> No® Contract Type:(Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 25,2014 Approved by <br /> Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: 7 <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Director of Information Technology Date: <br /> Risk Management a <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: JUL 3 1 2014 <br /> Office of Risk Management Date: y <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer a �� Date: V <br /> 8k�, <br /> Lezal Services <br /> This agreement is approved as to legal <br /> Office of the County Attorney Date: <br /> Revised 7/14 4 <br />