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DocuSign Envelope ID: FBE59735-B91D-4458-ABBA-952977038A66 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Ephesus Elementary School PTA Party/Vendor Contact Person: Kristen Stewart Contact <br /> Phone: 919/929-8715 Party/Vendor Address: 1495 Ephesus Church Road City Chapel Hill State:NC Zip: 27517 <br /> Department: EDC - Arts Commission Amount: $1,000 Purpose: Fall 2015 Arts Grant Award Budget Code(s): <br /> 37601020 683001 Vendor # 55065 (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 FYI county budget by BOCC -June <br /> 16,2015 <br /> This agreement is approved as to technical form and content: <br /> Docu5igned by: <br /> Department Director's Signature Svc j?4444 c , Date: <br /> 1/2/2016 <br /> 37BD4EFAC1BE410... <br /> Information Technologies <br /> (Applicable only to hcrdr>>cre/softivare 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 /> Docu5igned"by: �� <br /> Office of the Risk Management Officer <br /> Fausa, , r,OV'ttd 6 Date: 1/4/2016 <br /> 7FDCF9176800498... <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 Date: 1/4/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> igned by: <br /> Office of the County Attorney DocuS Date: 1/6/2016 <br /> 4035CE8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd 2corangecountync.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 />