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DocuSign Envelope ID: 1 FB3C60F-686F-4434-8500-FE7D2516331 E <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Ephesus Elementary School PTA Party/Vendor Contact Person: Darlene Reap-Klosty <br /> Contact Phone: 919-929-8715 Party/Vendor Address: 1495 Ephesus Church Rd. City Chapel Hill State: NC Zip: <br /> 27517 Department: COUNTYMGR/Arts Commision Amount: 1000.00 Purpose: Fall 2016 Arts Grants Budget <br /> Code(s): 37601020 683000 Vendor#55065 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑Non <br /> Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date 1/17/2017 Approved by Board <br /> Yes❑Non Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signatur 'M/US A Date: <br /> 0A3E81 B12B364B4... <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 Office Qt SX COV'htd,{fb Date: <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 Office rl A'u4°0- Date: <br /> 7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ocuSigned by: <br /> Office of the County Attorne Date: <br /> 4035CB8304CA4A9... <br /> Clerk 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 /> 6 <br /> Revised January 2017 <br />