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DocuSign Envelope ID:2BCB9E38-66BF-4CDC-9DC6-BC467846C8CA <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Tinka Jordy Party/Vendor Contact Person: Tinka Jordy Contact Phone: 919/757-2181 <br /> Party/Vendor Address: 1902 Borland Road City Hillsborough State: NC Zip: 27278 Department: EDC - Arts <br /> Commission Amount: $1,000 Purpose:Fall 2015 Arts Grant Award Budget Code(s):37601020 683001 Vendor# <br /> 59537 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No Contract Type: (Check one)New IZI <br /> Renewal ❑ Amendment ❑ Effective Date date of County Manager's signature Approved by Board Yes No <br /> ❑ Agenda Date: approval of FY16 county budget by BOCC-June 16,2015 <br /> This agreement is approved as to technical form and content: <br /> p DocuSigned by: <br /> 12/21/2015 <br /> Department Director's Si nature Sicvc $�axf � Date: <br /> .--37BD4EFAC1 BE410._ <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 /> p DocuSigned by: <br /> Office of the Risk Management Officer QLSo (bVIAA-lifb Date: 12/26/2015 <br /> \ 7FDCF9178800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer ( Aa Date: 12/28/2015 <br /> S7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney Date: 12/28/2015 <br /> Y Y . .;mot M I,«, <br /> 4035CB8304CA4A9 <br /> to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@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 /> 5 <br /> Revised June 2015 <br />