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DocuSign Envelope ID:7C75BF92-8D1F-4CCA-8FF3-53F903D1C845 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Gravelly Hill Middle School Party/Vendor Contact Person: Tracy Thomas Contact Phone: <br /> 919/245-4050 Party/Vendor Address: 4801 West Ten Road City Ef land State:NC Zip: 27243 Department:EDC <br /> - Arts Commission Amount: $505 Purpose: Fall 2015 Arts Grant Award Budget Code(s): 37601020 683001 <br /> Vendor# 178 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No Contract Type: (Check one) <br /> New ® Renewal ❑ Amendment ❑ Effective Date date of County Manager's signature Approved by Board <br /> Yes[Z]No❑ Agenda Date: approval of FY16 county budget by BOCC-June 16,2015 <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature "� 12/28/2015 <br /> $�cvc $��� 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 /> (DocuSigned""by:'���.�.. <br /> Office of the Risk Management Officer <br /> QUSA, Cm/ watt Date: 12/28/2015 <br /> °"°----7FDCF9178800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Govermnent Budget and Fiscal Control <br /> Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer � a Date: 12/28/2015 <br /> ( <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 � �, Date: 12/28/2015 <br /> 4 <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 /> Office of the Clerk to the Board Date: <br /> 5 <br /> Revised June 2015 <br />