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Contract Tracking (Funding from the Department) <br />This form should always be the first page of an offer or award package <br />submitted to Grants & Contracts Section for review and processing. The <br />Grants & Contracts Section will issue the Tracking and Contract numbers. <br />The Division will add the NCGrants ID# and notify G&C of the ID#. <br />ADFP Trust Fund Tracking #: ADM-ADFP-17-004 <br />Tracking #: <br />Contract #: /6 - C30 - y o ZO <br />NCGrants ID#: <br />(Non Profit, and For Profit Grantees) <br />CONTRACT TRACKING FORM <br />❑ Offer Date: 09/22/2017 1 El Award Date: <br />1. Division: Farmland Preservation <br />2. Project Leader/Contact: Dewitt Hardee Title: Program Manager Phone: 919-707-3069 <br />Email: dewift.hardee@ncagr.gov <br />3. Division Contact if different from Project <br />Leader: Veronica Jamison <br />Title: Administrative Officer <br />Phone: 919-707-3071 <br />Email: veronica.jamison@ncagr.gov <br />4. CRIS Program Name: Agricultural Development and Farmland Preservation <br />5. CRIS #: 1256 <br />6. Grantor Name: ADFP Trust Fund <br />7. Grantor A reement(Contract #: <br />8. CFDA # and Fed Program Name: <br />9. Project Title: Michael Barrier Farm Easement <br />10. Project Purpose: To protect the Farmland at Barrier Farm Easement <br />**If salaries are included in the Contract amount, complete & attach page 1A for tracking purposes** <br />11. Project Period: October 1, 2017 - September 30, 2019 <br />12. County of Primary Service: Cabarrus <br />13. Type of Contract: Federal Pass Through Z State ❑ Other (Explain) <br />14. Sub Award Amount: $60,146.00 <br />15. Match Required: N yes Amount: $9,021.90 no <br />**For required match, complete & attach Pae 1A for trackingpurposes <br />16. Are Indirect Costs Allowable? ❑ Yes No <br />If Yes — written prior approval from Budget & Finance must be obtained and attached <br />17. Retainage 20 % of Total Contract Award Withheld: $12,029.20❑ No <br />**Special A ro riations & Lump Sum < $100,000 or Waiver from Chief De Commissioner on file <br />18. Equipment in the Amount of $5,000 and Over to be purchased ❑ Yes ®No <br />**If Yes, complete & attach page 1A for tracking ur oses <br />19. Account #: 536E06 20. Center #: 2108-1014-2017 <br />21, Grantee Name: Cabarrus Soil & Water Conservation 122. Is the Grantee ❑ New I or ® Existing <br />23. Grantee Type: ® Non -Profit ® Governmental ❑ Private for Profit ❑ Individual <br />❑ Other (Explain) <br />24. Grantee Tax ID: 56-6000281 25. Grantee DUNS 965929263 <br />26. Tax Exempt Status Verified at Guidestar.org or IRS. ov - Initial & Date: 09/21/2017 VJ <br />27. Federal Debarment Status Verified at SAM. ov — Initial & Date: 09/21/2017 VJ <br />28. Grantee Fiscal Year End: 129. G.S. State Reporting Due Date: <br />Grants & Contracts Section <br />Offer/Award: El Yes ❑ No El n/a Is the Grantee on the State's "Suspension of Funding List?" <br />Tax Exempt Status Verified at Guidestar.org or IRS.gov - Initial & Date: <br />Federal Debarment Status Verified at SAM.gov — Initial & Date: <br />Attach this page to Page 1A, and/or Page 2 when amending or revising a current Contract, %aR�licfabl� <br />AM en num br 1 \n <br />Effective 7/1/07 <br />Rev: 7/14 F-10 Page 213 <br />