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DocuSign Envelope ID:B96D2CB4-5762-4D6D-8B05-3BE103D9D7D8 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Carrboro Elementary School PTA Party/Vendor Contact Person: Jillian la Serna Contact <br /> Phone: 919-968-3652 Party/Vendor Address: 400 Shelton St. City Carrboro State: NC Zip: 27510 Department: <br /> COUNTYMGR/Arts Commission Amount: 2056.00 Purpose: 2017-18 Arts Grants Budget Code(s): 37601020- <br /> 683000 Vendor# 55897 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: <br /> (Check one)New® Renewal ❑ Amendment ❑ Effective Date 8/17/2017 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 traws A Date: 8/23/2017 <br /> 0A3E81612836464... <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 /> c--DocuSigned by: <br /> Office of the Risk Management Officer [(USX CbrtAkftb Date: 8/25/2017 <br /> ``,. 7 FDC F9176800498... <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 rI 0o,Ia Date: 8/25/2017 <br /> 7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> /nI ocuSigned,"by: <br /> ♦'-�� <br /> Office of the County Attorney <br /> 0.t/UAA hark-tL 1 SCb Date: 8/25/2017 <br /> 079A4D525C0F4FB... <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 August 2017 <br />