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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> PartyNendor Name: Triangle J Council of Governments PartyNendor Contact Person: Mary Warren Contact <br /> Phone: 919-588-2707 PartyNendor Address: 4307 Emperor Blvd., Ste 110 City Durham State: NC Zip: 27703 <br /> partment: Aging Amount: $8,628 Purpose: Title III-D HPDP Funds of the Older Americans Act Budget <br /> CJ�Code(s): 10430105-444005 Vendor# 5855 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ <br /> Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 07/01/2016 Approved by Board <br /> Yes❑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 Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> Office of Risk Management Date: Z-3 7 <br /> Financial Services <br /> This instrument has been pre-audited in the in re ire7 the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: 2 <br /> Legal Services <br /> This agreement is approved as to legal f d su ' cy: <br /> Office of the County Attorney Date: 2 <br /> Clerk to the Board <br /> Received for record retention: <br /> c <br /> Office of the Clerk to the Board Date: <br /> Revised 2/17 <br />