2017-604 Co. Mgr. - NC Dept. of Agriculture and Consumer Services for the Orange County Crop Fund

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NORTH CAROLINA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES Steven W. Troxler, Commissioner NCDA&CS Farmland Preservation - North Carolina Agricultural Development and Farmland Preservation Trust Fund CONTRACT "CHECK OFF LIST" for Grantee INSTRUCTIONS• CHECK THE"YES"BOXES IN LEFT COLUMN FOR THE DOCUMENT TITLES THAT ARE BEING RETURNED WITH THE TWO SIGNED DATED and WITNESSED COPIES OF THE CONTRACT WITH SIGNATURES IN BLUE INK BE SURE TO INCLUDE ALL THE OTHER DOCUMENTS SPECIFIED IN YOUR CONTRACT PACKAGE IF "M NO"HAS BEEN CHECKED OFF FOR YOU THAT DOCUMENT IS NOT REOURED FOR THIS GRANT-PROGRAM OR PROJECT. GRANTEE ORGANIZATION NAME: Orange County PROJECT TITLE/NAME: Orange County Crop Fund CONTRACT #: 17- 67y-24)39" TRACKING #: 117 ADFP TRUST FUND TRACKING #: ADM-ADFP-16-015 DEPARTMENTAL GRANTS& GOVERNMENTAL DOCUMENT TITLE USE- CONTRACTS USE- ENTITIES ONLY ALL SIGNATURES MUST BE ZN BLUE INK DOCUMENTS DOCUMENTS Check one Box ATTACHED OR ON ATTACHED FILE ❑ Yes 0 No Contract"Check Off List"for Grantee Yes ❑ No Yes No ❑ Yes LJ No Contract Cover To be signed, dated &witnessed Yes Ej No Yes ❑ No ❑ Yes C3 No ATTACHMENT A- General Terms&Conditions n Yes n No Yes No ❑ Yes ❑ No ATTACHMENT B - Scope of Work ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ATTACHMENT C - Budget and Budget Narrative Yes No ❑ Yes No ❑ Yes No ATTACHMENT D - Project Timeline Yes ❑ No ❑ Yes No ❑ Yes No ATTACHMENT E - Owner Maintenance Agreement (Equipment Purchases Only) Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ATTACHMENT F - NCO enbook Supplemental Information ❑ mYesNo Yes No ❑ Yes ❑ No ATTACHMENT G - Performance Measures ❑ Yes No ❑ Yes ❑ No ATTACHMENT H - Certifications and Assurances ❑ ❑ Yes ❑ No ❑ Yes No ATTACHMENT I - Si nature Card El Yes R No Yes No ❑ Yes ❑ No ATTACHMENT J - W-9 Tax Information Yes No Yes No ❑ Yes 0 No ATTACHMENT K -Vendor Electronic Payment Form Yes Fl No Yes Cl No Effective 11115