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o Iq <br /> c2 -� <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name : Triangle J Council of Governments Area Agency on Aging Party/Vendor Contact Person : <br /> Mary Warren Contact Phone : 919 - 558 -2707 Party/Vendor Address : 4307 Emperor Blvd . , Ste 110 City Durham <br /> State : NC Zip : 27703 Department : Aging Amount : $ 3 , 500 Purpose . MIPPA Outreach Budget Code(s) . <br /> 10434005 -new Vendor # 5855 (N/A if new vendor) Vendor is a BOCC consultant ? Yes ❑ No ❑ Contract <br /> Type : (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 10/01 /2018 Approved by Board Yes <br /> ❑ No ❑ Agenda Date : <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this "project has not been initiated prior to execution of the agreement : <br /> Department Director ' s Signature4oeted <br /> - Date . e1 " <br /> Agreements for emergency services not subject to th bove affirmation . If services related to this <br /> agreement have already begun or be please briefly describe the nature of the emergency condition that <br /> was addressed : <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 /> / .j <br /> Office of the Risk Management Officer L ��_ Date : r . j <br /> Financial , ervices <br /> This instrument has been pre - audited in the in ner red by the Local Government Budget and Fiscal Control ► <br /> Act : <br /> Office of the Chief Financial Officer Date : ��� <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency : <br /> Office of the County Attorney � � f / U�t ! G'd�l,�' Date , 3h2W111i <br /> Clerk to the Board <br /> Received for record retention : <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion : smgersoll@orangecountync . 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 12/ 18 <br />