2022-508-E-DEAPR-North Carolina Department of Agriculture and Consumer Services-Approval of NCADFP grant contract for matached funds in acquisition of conservation easement of Poteat family farm

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NORTH CAROLINA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES Steven W. Troxler, 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: PROJECT TITLE/NAME: CONTRACT #: GO Entities Only Check One Box Document Title Department Use – Documents Attached or On File Grants and Contracts- Documents Attached 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 No Attachment A – General Terms and Conditions – Government/University Yes No Yes No Yes No Attachment B – Scope of Work (includes Timeline and Line Item Budget) Yes No Yes No Yes No Attachment C – Certifications and Assurances Section Yes No Yes No Yes No Attachment D – NC OpenBook Supplemental Information Yes No Yes No Yes No Attachment E – Signature Card Yes No Yes No Yes No Attachment F – W -9 Tax Information Yes No Yes No Yes No Attachment G – Vendor Electronic Payment Form Yes No Yes No Yes No Attachment H – FFATA Data Reporting Requirements (if applicable) Yes No Yes No Yes No Attachment I – Federal Regulations (if applicable) Yes No Yes 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. Orange County Poteat Family Farm Conservation Easement +/- 110 Acres 22-086-4003 x x X x X X x X X x X X x X X x X X X X X X X X DocuSign Envelope ID: 480AFBD4-654C-48FA-9CB8-F7C8D7E98DB2