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ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Party/Vendor Name: Teresa “TJ” Mundy and Shady Kimzey Party/Vendor Contact Person: Teresa “TJ” Mundy <br />Contact Phone: (571)246-1333 Party/Vendor Address: 106 N Oak St City Efland State: NC Zip: 27243 <br />Department: County Manager Amount: $3150 Purpose: Revocable License for Eno Mill Artist Studios <br />Budget Code(s): 37601003-470508-71390 Vendor N/A (N/A if new vendor) Vendor is a BOCC consultant? <br />Yes No <br /> Contract Type: (Check one) New Renewal Amendment Effective Date Approved by <br />Board Yes No Agenda Date: <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state <br />work on this project has not been initiated prior to execution of the agreement: <br />Department Director’s Signature ________________________________________ Date: ________ Agreements <br />for emergency services or repair are not subject to the above affirmation. If services related to this agreement have <br />already begun or been completed please briefly describe the nature of the emergency condition that was addressed: <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 Sherri Ingersoll upon completion: singersoll@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 />Revised 11/19 <br />DocuSign Envelope ID: 99B20BAC-B643-422E-A440-624EFACF102C <br />6/18/2024 <br />6/28/2024 <br />6/28/2024 <br />7/1/2024