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DocuSign Envelope ID:71 71A1 F5-8FF6-4COD-9E6C-2224164C181 D <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Northside Elementary School Party/Vendor Contact Person: Alder Keene Contact Phone: <br /> 919-918-2220 Party/Vendor Address: 350 Caldwell St City Chapel Hill State: NC Zip: 27516 Department: <br /> COUNTYMGR/Arts Commision Amount: 112.00 Purpose: Fall 2016 Arts Grants Budget Code(s): 37601020 <br /> 683001 Vendor # 62286 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: <br /> (Check one)New® Renewal❑ Amendment ❑ Effective Date 1/17/2017 Approved by Board Yes❑ No❑ <br /> Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signatur O'V'A tS 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:'' i1 <br /> Office of the Risk Management Office atSa Cori& e11ft Date: 2/2/2017 <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 Office r1" 0----&--- <br /> Date: 2/2/2017 <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 k hti Date: 2/6/2017 <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 />