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DocuSign Envelope ID:B7AD4BB0-0F90-476C-9970-303BC301A3B8 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Mark Elliott Party/Vendor Contact Person: Mark Elliott Contact Phone: 301-706-4585 <br /> Party/Vendor Address: 191 Riverbend Rd City Siler City State: NC Zip: 27344 Department: CNTYMGR/Arts <br /> Commision Amount: 5000.00 Purpose: Art for Animals Public Art Project Budget Code(s): $2240 from 37601020 <br /> 683000 (OCAC) and $2760 from 10215030-803000 (OC Animal Services) Vendor # 64440 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date date of Manager's signature Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signatur Curls Ait-G/1 -14, Date: 5/1/2017 <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 /> [(USX by: <br /> Office of the Risk Management Office [(USX C,bV'I�t,th Date: 5/2/2017 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the omcu igned anner by required by the Local Government Budget and Fiscal Control Act: <br /> : <br /> Office of the Chief Financial Office rI °" �°"L Date: 5/8/2017 <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 <br /> yc <br /> 4 kiv . Date: 5/8/2017 <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 /> Revised 2/17 5 <br />