OTHER-2022-048-NCADFP Grant Contract

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a NORTH CAROLINA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES Steven W. Troxier, Commissioner Contract Check Off List for Grantee (Government State Funded) INSTRUCTIONS : Check the "Yes" boxes in the left column for the document titles that are being returned with the two signed , dated and witnessed copies of the contract, with signatures in blue ink. Be sure to include all the other documents specified in your contract package . If "No" has been checked off for you , that document is not required for this grant program or project. GRANTEE ORGANIZATION NAME : Orange County PROJECT TITLE/NAME: Poteat Family Farm Conservation Easement +/- 110 Acres CONTRACT # : 22-0864003 GO Entities Only Document Title Department Use — Grants and Contracts- Check One Box Documents Attached Documents Attached or On File or On File Yes No Contractual " Check Off List for Grantee Yes No Yes No Yes No Contract Cover To be signed , dated & witnessed Yes No Yes No Yes X No Attachment A — General Terms and Conditions — Government/University Yes X No Yes x No Yes No Attachment B — Scope of Work includes Timeline and Line Item Budget) Yes No Yes No Yes x No Attachment C — Certifications and Assurances Section Yes x No Yes x No Yes x No Attachment D — NCO enBook Supplemental Information Yes x No Yes x No Yes x No Attachment E — Signature Card Yes x No Yes x No Yes X No Attachment F — W 9 Tax Information Yes x No Yes x No Yes X No Attachment G — Vendor Electronic Payment Form Yes x No Yes x No Yes x No Yes x No Yes x No Yes x No Yes x No Yes x No Rev. 6/17, 4/22 Attachments A, C-K have all been signed prior to contract signing and are saved in ADFP's files .