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DocuSign Envelope ID: 34C3530B-CA48-4354-96A4-14CAAF7A9A33 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Jay's Chicken Shack, LLC Party/Vendor Contact Person: Kim Mangal Contact <br /> Phone: 919-732-3591 Party/Vendor Address: 646 N. Churton Street City Hillsborough State: NC Zip: <br /> 27278 Department: Economic Development Amount: $5,000.00 Purpose: Business Investment Grant <br /> Award Budget Code(s): 34600020-900051 Vendor # N/A (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No ❑ Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date November 10, 2016 Approved by Board Yes ❑ No ❑ Agenda Date: <br /> This agreement is approved as to technica 7�17RF)4F-F-A(-j UR.. cmnptent: <br /> t B44,.x.� 11/23/2016 <br /> Department Director's Signature BE410 Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services) This agreement has been reviewed <br /> and is approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency 5ursa$iecc I dards, specifications, and requirements: <br /> k (,e 11/28/2016 <br /> Office of the Risk Management Officer 7FDCF9176800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal <br /> Control Act: DocuSigned by: <br /> 481A14 11/28/2016 <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as to le 7n,iWA&SUfficiency: <br /> s ���� 11/28/2016 <br /> Office of the County Attorney Date: <br /> Clerk to the Board <br /> Received for record retention: All DocuSign contracts must be copied to Donna Lloyd upon completion <br /> @ Dolloy ftoran ecountvnc.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 /> OCEDbiga June 2016 <br />