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DocuSign Envelope ID: FF904CCC-8943-46A2-B042-006AF1407ED4 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Central Elementary School Party/Vendor Contact Person: Myron Wilson Contact Phone: <br /> 919/732-3622 Party/Vendor Address: 154 Haves Street City Hillsborough State: NC Zip: 27278 Department: <br /> EDC - Arts Commission Amount: $5,000 Purpose: Fall 2015 Arts Grant Award Budget Code(s): 37601020 <br /> 683001 Vendor ff 178 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: <br /> (Check one)New ® Renewal ❑ Amendment ❑ Effective Date date of County Manager's signature Approved <br /> by Board Yes®No❑ Agenda Date: approval of FYI county budget by BOCC-June 16,2015 <br /> This agreement is approved as to technical form and content: <br /> 5igned by: <br /> Department Director's Signature FZ9444.11c, Date: 1/7/2016 <br /> 37BD4EFAC1BE410... <br /> Information Technologies <br /> (Applicable only to hardivare/sofhvare pzn-chases 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 /> ''��.�.. <br /> Office of the Risk Management Officer Fausa, r,Orv�c,i16 Date: 1/8/2016 <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 s�gz. ao-z Date: 1/13/2016 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> 1/13/2016 <br /> Office of the County Attorney r Date: <br /> 4035CE8304CA4A9... <br /> Cleric to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@oran eg countynagov <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 />