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4 <br /> NORTH CAROLINA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES <br /> Steven W.Troxler, Commissioner <br /> Agreement Check Off List for Grantee(Government State/Other Funded) <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 /> agreement, with signatures in blue ink. Be sure to include all the other documents specified in your agreement 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: County of Orange <br /> AGREEMENT TITLE/NAME: Oran a Local A ricultural Growth Zone TRACKING#: ADFP-ORA-I7-AGZ-000 <br /> GO Entities Only Document Title Department Use- Grants and Contracts- <br /> Check One Box Documents Attached Documents Attached <br /> or On File or On File <br /> Yes No Agreement Check Off List for Grantee _ Yes No Yes No <br /> Yes No Agreement Cover(To be signed, dated &witnessed) _ Yes No Yes No <br /> Yes No Scope of Work(includes Line Item Budget) Yes No Yes No <br /> Yes No Terms and Conditions Yes No Yes No <br /> Yes No Yes No Ye—s--7- No <br /> Yes No Yes No Yes No <br /> Yes No Yes No YesNo <br /> Yes No Yes No Yes No <br /> Yes No Yes No Yes No <br /> Yes No Yes No Yes No <br /> Rev.6/17,4/22,9/22 <br />