2018-140 Economic Dev - NC Dept of Agriculture Agritourism marketing grant

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Attachment E Signature Card �. `,Ffj j, , \rl� X'i CONTRACT & FINANCIAL DOCUMENTS INSTRUCTIONS: Please read and fill in the required information to the right of each field where applicable. Signatures must match the Contract signatures. In the event the affixed signature(s) are no longer valid, a revised form must be submitted prior to processing any contractual documents or submitting "Request for Payments" or any other financial documents. If more than two people will sign for the organization, this form may be duplicated. SECTION I. Date: April 16, 2018 Legal Applicant Organization /Agency Name: Orange County Government Federal Tax Identification Number: 56- 6000327 SECTION II. Certification: By affixing my signature below, I certify that person(s) identified are designated having legal authorization to sign on behalf of the organization named in Section I., above, for purposes of executing contractual documents and preparing, approving and executing all financial documents; including "Requests for Payments." I understand the legal implications of any and all misrepresentation, which include but are not limited to defrauding the State of North Carolina, and certify that the person signing below has full authority to execute this Agreement on behalf of the named organization. NON - GOVERNMENTAL ORGANIZATIONS ONLY Must match Contract signature) Board Chair, Executive Director, etc. Financial Representative, Treasurer, etc. Print Name & Title: Print Name & Title: Signature: Signature: GOVERNMENTAL ENTITIES (Must match Contract signature) Authorized Governmental Official Chief Fiscal Officer Print Name & Title: Print Name & Title: Bonnie Hammersley, County Manager Gary D aldson, Whief Financial Officer Signature. Signatur NCDA &CS - Signature Card — NGO & Governmental Page 1 of 1 Rev 7/14; 1/17; 11 /17