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a / � - <br /> ORANGE COUNTY - DEPARTMENT USE ONLY - HARD COPY ONLY <br /> Department <br /> Party/Vendor Name : Triangle J Council of Governments Party/Vendor Contact Person : Mary Warren Contact <br /> Phone : 919 - 58 &2707 Party/Vendor Address : 4307 Emperor Blvd . , Ste 110 City Durham State : NC Zip : 27703 <br /> Department : Aging Amount $ 8 669 . 00 Purpose : Title III- D Health Promotion/Disease Prevention grant Budget <br /> Code( s) : 10430105444005 &ohr # 5855 (N/A if new vendor) Vendor is a BOCC consultant ? Yes ❑ No [:]Contract Type : (Check one Renewal ® Amendment ❑ Effective Date Approved by Board <br /> fPA Yes [:] No ❑ Agenda Date : <br /> This agreement is approved as to technical form and content : <br /> Department Director ' s SignatureQ Date : /.Z` 04Ar <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 42 Date : <br /> Financial Services <br /> This instrument has been pre- audited in the ann r ired by the Local Government Budget and Fiscal Control <br /> Act . <br /> Office of the Chief Financial Officer Date . Z 7 <br /> Leiial Services <br /> This agreement is approved as to legal for an sufficiency : p <br /> 00 <br /> Office of the County Attorney _ Date : I a <br /> Clerk to the board <br /> Received for record retention : <br /> Office of the Clerk to the Board Date : <br /> Revised 10/ 17 <br />