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�20I '1 , <br /> 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 /> Ellison Jones Contact Phone: 919.558.2909 Party/Vendor Address: 4307 Emperor Blvd., Suite 110 City Durham <br /> State: NC Zip: 27703 Department: Aging Amount: $42,073 Purpose: NC Family Caregiver Support Program�n <br /> Budget Code(s): 10432005-444106. Vendor#5855 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ <br /> No[] Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 7/01/2017 Approved by <br /> Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature b4�� 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: <br /> Financial Services <br /> This instrument has been pre-audited in the m re ' e by he Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: <br /> Lezal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney t ! _f i/� 4c /t" Date: <br /> erk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: / <br /> Revised 2/17 <br />