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DocuSign Envelope ID:21562812-A278-42AD-8638-D61555DD549A <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Triangle J Council of Governments Party/Vendor Contact Person: Judy Weller Contact Phone: <br /> 919-549-0551 Party/Vendor Address: 4307 Emperor Blvd, Suite 110 City Durham State: NC Zip: 27703 <br /> Department: Amount: $15,000.00 Purpose: Drug and Alcohol Testing Program Budget Code(s): <br /> 10295020/720033 Vendor# 5855 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br /> Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date Approved by Board Yes❑No® <br /> Agenda Date: <br /> This agreement is approved as to to bod content: <br /> Department Director's Signature bayUhmt,w Date: 11/14/2016 <br /> 81'C9862'6z3FU1%18F'.. <br /> i <br /> u <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 /> ii <br /> Risk Management <br /> This agreement is approved for sufficiency Z"77"bylandards,specifications, and requirements: <br /> hvw ltb 11/28/2016 <br /> Office of the Risk Management Officer Date: <br /> — eF�aseaoase--_.- <br /> Financial Services <br /> This instrument has been pre-audited' oraaa� uQquired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer � o Date: 11/30/2016 <br /> Legal Services <br /> This agreement is approved as to le �o&g ,W,�,sufficiency, <br /> Office of the County Attorney am Date: 11/30/2016 <br /> 4035CB8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgworangecountyna.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 6/16 5 <br />