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6 <br />Revised August 2022 <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: 2022-23 Arts Grants Budget Code(s): 30601020-683000-96060 Vendor # (N/A if new vendor) Vendor <br />is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective <br />No Date 4-14-2023 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 Laura Jensen upon completion @ ljensen@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 />Town of Chapel Hill Community Arts & Culture Susan Brown 9199692034 <br />100 Library Dr Chapel Hill 27514 $3,500 <br />64, REMIT 21 <br />DocuSign Envelope ID: 3E20966A-665E-4671-8D52-F75F4724C46F <br />5/29/2023 <br />5/30/2023 <br />5/30/2023