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Revised 06/21 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: Triangle J. Council of Governments (TJCOG) Party/Vendor Contact Person: Lee Worsley <br />Contact Phone: 919-558-9395 Party/Vendor Address: 4307 Emperor Blvd., Suite 110 City Durham State: NC Zip: <br />27703 Department: Planning Amount: $4,276.00 for FY23, not to exceed $15,000 total for FY23, FY24 and FY25 <br />combined Purpose: Clean Water Education Partnership (CWEP) Membership Dues for FY22-23 Budget Code(s): <br />#10695020-719037-72089 Vendor # 5855 (N/A if new vendor) Vendor is a BOCC consultant? Yes No <br />Contract Type: (Check one) New Renewal Amendment Effective Date July 1, 2022 Approved by Board <br />Yes No Agenda Date: --- For Section XIV. c. contracts only, Approved by Board in Current FY Budget <br />Yes No <br /> <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br />this project has not been initiated prior to execution of the agreement: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br />Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br />agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br />was addressed: Travis Myren (Deputy County Manager) signing for Cy Stober (Director) <br /> <br />Information Technologies <br /> <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 /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br />Clerk to the Board <br /> <br />Received for record retention: <br />All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />DocuSign Envelope ID: 5AE067FF-886E-4F6C-BEC4-4A7853E492A8 <br />8/16/2022 <br />8/16/2022 <br />8/18/2022 <br />8/19/2022