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DocuSign Envelope ID:06711178-0E3F-4541-A834-A91 FC422F4D1 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Carrboro Elementary School Party/Vendor Contact Person: Jillian LaSerna Contact Phone: <br /> 919-968-3652 Party/Vendor Address: 400 Shelton St. City Carrboro State: NC Zip: 27510 Department: <br /> COUNTYMGR/Arts Commision Amount: 1000.00 Purpose: Fall 2016 Arts Grants Budget Code(s): 37601020 <br /> 683001 Vendor# 55897 (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 Signatu r[i1W1S "' 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 /> /I DocuSigned by: <br /> Office of the Risk Management Offic a�Sa. Co b 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 rIA,1641 Art.4 Date: 2/8/2017 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ocuSigned by: <br /> y �, Date: 2/9/2017 <br /> Office of the County Attorne <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 />