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DocuSign Envelope ID:684BD205-E201-4917-A887-C6D2D5CC92C7 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Max Puhala Party/Vendor Contact Person: Max Puhala Contact Phone: 336/707-7356 <br /> Party/Vendor Address: 6123 Farrington Road, M7 City Chapel Hill State: NC Zip: 27517 Department: EDC - <br /> Arts Commission Amount: $300 Purpose: Spring 2015 Arts Grant Award Budget Code(s): 37601020 683001 <br /> Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one) <br /> New ® Renewal ❑ Amendment ❑ Effective Date date of CouM Manager's signature Approved by Board <br /> Yes®No❑ Agenda Date: approval of FY16 county budget by BOCC-June 16,2015 <br /> This agreement is approved as to tec ' ab&wmand content: <br /> S:we $ <br /> Department Director's Signature cgF Date: 6/19/2015 <br /> �e® ac7 a�-a, ... <br /> Information Technologies <br /> (Applicable only to harchi are/softlVare 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 sufficienc y jA§&yjRgqq,$andards,specifications,and requirements: <br /> rbvvt,e,tt0 <br /> Office of the Risk Management Officer QuSA, Date: 6/19/2015 <br /> 7FDCFM ... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officer to D""`bvu Date: 6/19/2015 <br /> D>=Fe�eFaBar ... <br /> Legal Services <br /> This agreement is approved as to sufficiency: <br /> Office of the County Attorney 4"J ,1�, Date: 6/19/2015 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountyna.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Cleric to the Board Date: <br /> 5 <br /> Revised June 2015 <br />