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6 <br />Revised July 2018 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: The Art Therapy InstituteParty/Vendor Contact Person: Hillary RubesinContact Phone: <br />6103487253Party/Vendor Address: 200 N. Greensboro St., Ste D-6City CarrboroState: NCZip: 27510 <br />Department: COUNTYMGR/Arts CommissionAmount: $1,780Purpose: 2018-19Arts GrantsBudget Code(s): <br />37601020-683000Vendor # 63288(N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract <br />Type: (Check one) New Renewal Amendment Effective Date 8/8/2018Approved by Board Yes <br />No Agenda Date: <br />This agreement is approved as to technical form and content: <br />Department Director’s Signature ________________________________________ Date: ________ <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 />Office of the Risk Management Officer___________________________________ Date: _________ <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 />Office of the Chief Financial Officer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________Date: ________ <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 />DocuSign Envelope ID: BD01B7A1-D313-4F02-9F0E-C26DFFC84BEE <br /> <br /> <br /> <br />