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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: Triangle J Council of Governments Area Agency on Aging Party/Vendor Contact Person: <br /> Mary Warren Contact Phone: 919.558.2909 Party/Vendor Address: 4307 Emperor Blvd., Suite 110 City Durham VV'' <br /> State: NC Zip: 27703 Department: Aging Amount: $592,820 Purpose: Home & Community Block Grant <br /> Budget Code(s): 10430105-444000 10430105-448916 10432005-444103 10435005-44500 SS Senior Care 7 <br /> Inc. Vendor# 5855 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No[] ct Type: (Check , <br /> one) New ❑ Renewal ® Amendment ❑ Effective Date 7/01/2017 Approved by Board Yes® No❑ <br /> Agenda Date:May 16,2017 <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature •,11� Date: -1 <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 2- ,( /( ice 7 Date: <br /> Xmanci"erkes <br /> This instrument has been pre-audited in the er qu' e y the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: 7 <br /> Leval Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney gA( 1 '���� �' Date: '1 ►^i <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board <br /> Date: <br /> Revised 2117 <br />