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DocuSign Envelope ID:45C10885-A71D-4B4F-9lB3-E01ADC379354 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Art Therapy Institute of NC Party/Vendor Contact Person: Bridget Pemberton-Smith <br /> Contact Phone: 919-605-2081 Party/Vendor Address: 200 N Greensboro St. City Carrboro State: NC Zip: 27510 <br /> Department: Cnty Mn gr Amount: 5,000 Purpose: 2020 Operations Support Grant Budget Code(s): 37601020- <br /> 683010 Vendor # 63288 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: <br /> (Check one)New ❑ Renewal ❑ Amendment ❑ Effective Date Approved by Board Yes❑ No❑ <br /> Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> Docu Signed by: <br /> Department Director's Signature firms fthMA`" Date: 11/3/2020 <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: <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 i Ww"§tandards,specifications,and requirements: <br /> 9USa b 11/3/2020 <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: DocuSigned by: <br /> Office of the Chief Financial Officer +2.14.� Date: 11/3/2020 <br /> sai=�rsr�eer$ <br /> Legal Services <br /> This agreement is approved as t �alnfiv and sufficiency: <br /> Office of the County Attorne �' " '�h� Date: 11/5/2020 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@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 October 2020 <br />