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DocuSign Envelope ID:0E33E5E7-2F9B-4F3C-9COD-95D21AC52620 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Seawell Elementary School PTA Party/Vendor Contact Person: Jill Austin Contact Phone: <br /> 919-967-4343 Party/Vendor Address: 9115 Seawell School Rd City Chapel Hill State: NC Zip: 27516 <br /> Department: COUNTYMGR/Arts Commision Amount: 1000.00 Purpose: Fall 2016 Arts Grants Budget Code(s): <br /> 37601020 683001 Vendor#55022 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑ No Contract <br /> Type: (Check one)New ® Renewal ❑ Amendment ® Effective Date 1/17/2017 Approved by Board Yes <br /> No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signatur %VAS AbiV'un, 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""vt,by: <br /> ''��.. <br /> Office of the Risk Management Office aUSX �,bv Date: 1/30/2017 <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 (1 0,44.zi. Date: 1/30/2017 <br /> 7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> r---DocuSigned by: <br /> 1/31/2017 <br /> Office of the County Attorney ,, k Date: <br /> k—4035C B8304CA4A9... <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 />