HomeMy WebLinkAboutR 2015-200 Aging - Triangle J Council of Governments Area Agency on Aging - Contract of County Based MIPPA Services DocuSign Envelope ID:871596FB-EB3F-4768-BC79-A5D9ADF74E87
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Triangle J Council of Governments Area Agency on Aging Party/Vendor Contact Person: Joan
Pellettier Contact Phone: 919.549.0551 Party/Vendor Address:4307 Emperor Blvd, Ste 110 City Durham State:NC
Zip: 27703 Department: Aging Amount:MM Purpose: Medicare Outreach(MIPPA) Budget Code(s): 10432005-
444128 Vendor#5855 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Check
one) New ❑ Renewal ® Amendment ❑ Effective Date 09/30/2014 Approved by Board Yes❑ No❑
Agenda Date:
This agreement is approved as to tec ab�iar;lx�sad content:
Department Director's Signature
fiy�l' Date: 4/23/2015
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficienc bawamestandards,specifications,and requirements:
Q�ISA �,OYVI.I 6 4/24/2015
Office of the Risk Management Officer Date:
Financial Services
This instrument has been pre-audited in t 4 i ed by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date: 4/24/2015
Legal Services
This agreement is approved as to legal fo ®iafey:
(� 4/28/2015
Office of the County Attorney rb � Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecoun!ync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 10/14 4