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Quoted on: <br />County or Entity: <br />Accepted by: <br />Signature <br />Printed Name <br />Print Title <br />Date <br />Financial Officer: <br />Signature <br />Date <br />Please sign and return the accepted proposal by June 15th, 2021. <br />This instrument has been pre-audited in the manner required by the Government Budget and Fiscal Control <br />Act. <br />$868,160 <br />Annual Payment Plan: <br /> renewal application may result in changes to the Estimated Contribution: <br />Payment Plan Available: Liability & Property Pool <br />Orange County <br />6/2/2021 <br />I understand that changes made to the exposures subsequent to submission of the <br />We appreciate your participation. To insure effective, efficient operation of your Pool we <br />must receive payment in full no later than August 1st. A two percent late payment fee will be <br />assessed on all amounts received after that date. <br />NCACC 6/2/2021 <br />6/17/21 <br />6/17/21 <br />County Manager <br />Bonnie B. Hammersley <br />DocuSign Envelope ID: 4BC4D079-09BF-4F15-BDA0-A24B1EDE73EF