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DocuSign Envelope ID:85BAA72B-7C62-4B2E-AB73-C8822718381E <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Ephesus Elementary School PTA Party/Vendor Contact Person: Elizabeth Portnoy Contact <br /> Phone: 267-679-8935 Party/Vendor Address: 2453 Sedgefield Dr. City Chapel Hill State: NC Zip: 27514 <br /> Department: Art Commition Amount: $1.000 Purpose: Spring 2016 Arts Grant Award Budget Code(s): <br /> 37601020-683000 Vendor#55065 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No[] Contract <br /> Type: (Check one) New ❑ Renewal ❑ Amendment ❑ Effective Date_ Approved by Board Yes❑ No❑ <br /> Agenda Date: <br /> This agreement is approved as to tec eb�gCl6�content: <br /> Department Director's Signature 5;kvc $��"`�"� Date: 8/16/2016 <br /> 378D4EFAC1 BE410... <br /> Information Technolosies <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 o ' &uj7 ",indards, specifications,and requirements: <br /> gusa. r,Orv�c X16 8/16/2016 <br /> Office of the Risk Management Officer Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officer Date: 8/16/2016 <br /> Legal Services <br /> This agreement is approved as to 1 lbsufficiency: <br /> Office of the County Attorney 4�,q 1` Date: 8/17/2016 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.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 />