2024-492-E-DEAPR-NC Department of Agriculture & Consumer Services -Reimbursement Grant

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Signature Card Page 1 of 1 NCDA&CS - Signature Card – NGO & Governmental Rev 7/14; 1/17;11/17 CONTRACT & FINANCIAL DOCUMENTS INSTRUCTIONS: Please read and fill in the required information to the right of each field where applicable. Signatures must match the Contract signatures. In the event the affixed signature(s) are no longer valid, a revised form must be submitted prior to processing any contractual documents or submitting “Request for Payments” or any other financial documents. If more than two people will sign for the organization, this form may be duplicated. SECTION I. Date: Legal Applicant Organization/Agency Name: Federal Tax Identification Number: SECTION II. Certification: By affixing my signature below, I certify that person(s) identified are designated having legal authorization to sign on behalf of the organization named in Section I., above, for purposes of executing contractual documents and preparing, approving and executing all financial documents; including “Requests for Payments.” I understand the legal implications of any and all misrepresentation, which include but are not limited to defrauding the State of North Carolina, and certify that the person signing below has full authority to execute this Agreement on behalf of the named organization. NON-GOVERNMENTAL ORGANIZATIONS ONLY (Must match Contract signature) Board Chair, Executive Director, etc. Financial Representative, Treasurer, etc. Print Name & Title: Print Name & Title: Signature: Signature: GOVERNMENTAL ENTITIES (Must match Contract signature) Authorized Governmental Official Chief Fiscal Officer Print Name & Title: Print Name & Title: Signature: Signature: Attachment E Orange Soil and Water Conservation District 56-6000327 Gail Hughes, Board Chair Richal Vanhook, Board Treasurer Docusign Envelope ID: A3C70ABF-EEDE-4822-BD1B-5001B2220A24Docusign Envelope ID: 4952E7F3-6FA3-4165-AD14-AFD0F6E1AE85