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NORTH CAROLINA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES <br />Steven W. Troxler, Commissioner <br />NCDA&CS Farmland Preservation - North Carolina Agricultural Development and Farmland Preservation <br />Trust Fund <br />CONTRACT "CHECK OFF LIST" for Grantee <br />INSTRUCTIONS: CHECK THE "YES" BOXES IN LEFT COLUMN FOR THE DOCUMENT TITLES THAT ARE BEING RETURNED WITH THE TWO SIGNED. DATED and <br />WITNESSED COPIES OF THE CONTRACT, WITH SIGNATURES IN BLUE INK. BE SURE TO INCLUDE ALL THE OTHER DOCUMENTS SPECIFIED IN YOUR CONTRACT <br />PACKAGE. IF -M NO" HAS BEEN CHECKED OFF FOR YOU, THAT DOCUMENT IS NOT REOURED FOR THIS GRANT PROGRAM OR PROJECT. <br />GRANTEE ORGANIZATION NAME: Cabarrus Soil & Water Conservation District <br />PROJECT TITLE/NAME: Michael Barrier Farm Easement <br />CONTRACT #: /(p 030-- �Z Q TRACKING #: <br />ADFP TRUST FUND TRACKING #: ADM-ADFP-17-004 <br />GOVERNMENTAL <br />ENTITIES ONLY <br />Check one Box <br />DOCUMENT TITLE <br />ALL SIGNATURES MUST BE IN BLUE INK <br />DEPARTMENTAL <br />USE - <br />DOCUMENTS <br />ATTACHED OR ON <br />FILE <br />GRANTS & <br />CONTRACTS USE - <br />DOCUMENTS <br />ATTACHED <br />❑ Yes <br />❑ No <br />Contract "Check Off List" for Grantee <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />Contract Cover To be signed, dated & witnessed <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />ATTACHMENT A - General Terms & Conditions <br />❑ Yes <br />[-I No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />ATTACHMENT B - Scope of Work <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />ATTACHMENT C - Budget and Budget Narrative <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />El Yes <br />El No <br />ATTACHMENT D - Project Timeline <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />ATTACHMENT E - The Conservation Easement Content <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />ATTACHMENT F - Option to Purchase an ADFP Agricultural Easement <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />ATTACHMENT G - NCO enbook Supplemental Information <br />El Yes <br />❑ No <br />ET Yes <br />❑ No <br />❑ Yes <br />❑ No <br />ATTACHMENT H - Performance Measures <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />El No <br />ATTACHMENT I - Certifications and Assurances <br />Yes <br />❑ No <br />Yes <br />L1 No <br />❑ Yes <br />F-1No <br />ATTACHMENT J - Si nature Card <br />Yes <br />❑ No <br />EJYes <br />❑ No <br />3 ❑Yes <br />Ll N2 <br />ATTACHMENT K - W-9 Tax Information <br />❑ Yes <br />01 No <br />❑ Yes <br />LJ No <br />E] Yes <br />L] No <br />ATTACHMENT L - Vendor Electronic Payment Form <br />ElYes <br />[:1 No <br />❑ Yes <br />❑ No <br />3 <br />Egfective 08/16 <br />F-10 Page 215 <br />