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ORANGE COUNTY-DEPARTMENT USE ONLY I r _ 2 ) O <br /> Department �/ J! <br /> Party/Vendor Name: Triangle J Council of Governments Area Agency on Aging_(TJAAA) Party/Vendor Contact <br /> Person: Mary Warren Contact Phone: 919-558-2707 Party/Vendor Address: 4307 Emperor Blvd., Ste 110 City <br /> Durham State:NC Zip:27703 Department:Aging Amount: $3,500 Purpose:Medicare Improvements for Patients <br /> and Providers Act(MIPPA) Budget Code(s): 10432005-444128v#endor#5855 (N/A if new vendor) Vendor is <br /> a BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal Z Amendment ❑ Effective <br /> Date 10101115 Approved by Board Yes❑Non Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: —_6 <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 <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> Office of Risk Management�I L '4 Date 6 <br /> Financial Services <br /> This instrument has been pre-audited in the anne equir by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: 2-3 <br /> Legal Services <br /> This agreement is approved as to legal fo d su iency: <br /> Office of the County Attorney Date: f7 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br />