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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department 1 <br /> Party/Vendor Name: TTialngle J Council of Governments Party/Vendor Contact Person: Mary Warren Contact <br /> Phone: 919-588-2707 Party/Vendor Address: 4307 Emperor Blvd., Ste 110 City Durham State: NC Zip: 27703 <br /> Department: Aging Amount: $550,104 Purpose: Home and Community Care Block Grant Budget Code(s): <br /> multiple Vendor# 5855 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: <br /> (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 07101/2015 Approved by Board Yes® No <br /> ❑ Agenda Date:6/02/2015 <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature ti 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 Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> Office of the Risk Management Officer � 60 Date: <br /> Financial Services <br /> This instrument has been pre-audited in the moiner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: 2 L <br /> , f/ — <br /> Legal Services <br /> This agreement is approved as to legal nd su iency: <br /> Office of the County Attorney Date: 2-3 }(j <br /> a z� s <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloydQoran eg countync.eov <br /> The following signature block is for hard cop' n d is required for Docusign contracts: J_ <br /> Office of the Clerk to the Board Date:_�j�l <br />