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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> NOT A CONTRACT EXHIBIT OR ATTACHMENT <br /> Department <br /> Party/Vendor Name.�Ll�€Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: <br /> City State: Zip: Department: Aging-CBS Amount: Purpose: Instructor Budget <br /> Code(s): 10430120-629000 Vendor 4 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ <br /> Contract Type: (Check one)New ❑ Renewal ❑ Amendment ❑ Effective Date Approved by Board Yes <br /> ❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: <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 Mana eg ment <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements <br /> �� _ SEP 2 2014 <br /> Office of Risk Management !� Date: � <br /> BY <br /> Financial Services <br /> This instrument has been pre-audited in the manner require by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as to legal fo and sufficiency: <br /> Office of the County Attorney Date: <br /> Revised 7/14 4 <br />