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DocuSign Envelope ID:9ADCCDBF-8A1A-4A6C-B366-3CDODAD161AB <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: McDougle Elementary School PTA Party/Vendor Contact Person: Carolina Mejia-Davis <br /> Contact Phone: 919/969-2435 Party/Vendor Address: 890 Old Fayetteville Road City Chapel Hill State:NC Zip: <br /> 27516 Department: EDC - Arts Commission Amount: $1,000 Purpose: Fall 2015 Arts Grant Award Budget <br /> Code(s): 37601020 683001 Vendor#22226#6 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No <br /> ® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date date of County Manager's <br /> signature Approved by Board Yes No❑ Agenda Date: approval of FY16 county budget by BOCC -June <br /> 16,2015 <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature Svc $4414&5 Date: <br /> 12/27/2015 <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 /> DocuSigned by: �.�. <br /> Office of the Risk Management Officer <br /> QLt 0, (OVIAL{{O Date: 12/28/2015 <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 (2 Date: 12/28/2015 <br /> • 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney isunti Date: 12/28/2015 <br /> 4035CB8304CA4A9 <br /> to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd a,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 /> 5 <br /> Revised June 2015 <br />