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6 <br />Revised July 2018 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: <br /> City State: NC Zip: Department: COUNTYMGR/Arts Commission Amount: <br />Purpose: 2021-22 Arts Grants Budget Code(s): 37601020-683000 Vendor # (N/A if new vendor) Vendor <br />is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective <br />NoDate 8-27-2021 Approved by Board Yes 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 />AhDream Smith AhDream Smith 901-218-5626 <br />329 Burlage Circle Chapel Hill 27514 $1,636.00 <br />67322 <br />DocuSign Envelope ID: 48CFDFAE-78BE-4FFA-BE3A-FC030E7B0208 <br />10/14/2021 <br />10/14/2021 <br />10/18/2021 <br />10/18/2021