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NORTH CAROLINA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES <br />Steven W. Troxler, Commissioner <br />Contract Check Off List for Grantee (Government State Funds) <br />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 <br />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 <br />document is not required for this grant program or project. <br />GRANTEE ORGANIZATION NAME: Orange SWCD <br />PROJECT TITLE/NAME: Streamflow Rehab Assistance Program <br />CONTRACT #: 25-008-4001 <br /> GO Entities Only <br />Check One Box <br />Document Title Department Use – <br />Documents Attached <br />or On File <br />Grants and Contracts- <br />Documents Attached <br />or On File <br />Yes No Contractual “Check Off List for Grantee Yes No Yes No <br />Yes No Contract Cover (To be signed, dated & witnessed) Yes No Yes No <br />Yes No Attachment A – General Terms and Conditions – Government/University Yes No Yes No <br />Yes No Attachment B – Scope of Work (includes Timeline and Line Item Budget) Yes No Yes No <br />Yes No Attachment C – Certifications and Assurances Section Yes No Yes No <br />Yes No Attachment D – NC OpenBook Supplemental Information Yes No Yes No <br />Yes No Attachment E – Signature Card Yes No Yes No <br />Yes X No Attachment F – StreamFlow Assistance 50% Progress Report*** Yes X No Yes No <br />Yes X No Attachment G – Streamflow Rehabilitation Assistance Program (StRAP) Quarterly Progress Report*** Yes X No Yes No <br />Yes X No Attachment H- Request for Payment form*** Yes X No Yes No <br />Yes X No Attachment I – Request of payment Summary*** Yes X No Yes No <br />Yes X No Attachment J- Equipment Log*** Yes X No Yes No <br />Yes X No Attachment K – Time Log*** Yes X No Yes No <br />** NC Substitute W-9 and VEP forms are already on file and won't be required to be collected with contract. <br />Rev. 6/17, 4/22 ***Attachments F, G and H do NOT need to be returned with the final contract <br />XX <br />X <br />X <br />X <br />X <br />X <br />Docusign Envelope ID: A3C70ABF-EEDE-4822-BD1B-5001B2220A24Docusign Envelope ID: 4952E7F3-6FA3-4165-AD14-AFD0F6E1AE85