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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 submitted to Grants & Contracts Section for review and <br />processing. The Grants & Contracts Section will issue the Contract numbers. The Division will add the NCGrants ID# and notify G&C <br />of the ID# or directly enter it into WebGT. Attach this page to Page 1A, and/or Page 2 when amending or revising a current Contract, <br />as applicable. <br />Eff: 7107; Rev: 7/14;1/17 <br />F-7 Page 116 <br />CONTRACT TRACKING FORM <br />Contract # : 17-095-4033 NCGrants ID #: <br />1. <br />Division: Farmland Preservation <br />2. <br />Parent Record: 17 -095 -FP <br />Is the Grantee New? <br />3. <br />Grantee Name: Cabarrus Soil and Water Conservation District <br />4. <br />Grantee Tax ID: 56-60002811 <br />Grantee DUNS:965929263 <br />5. <br />Grantee Type: LJ Nonprofit ■ Government For Profit LJ Individual <br />6. <br />Address PO/Street:715 Cabarrus Ave W <br />7. <br />City/State/Zip: Concord INC 28027 <br />8. <br />Grantee Coun :Cabarrus <br />9. <br />Grantee Fiscal Year End: July 1 <br />10. <br />Payee Name if applicable): Daniel McClellan, Cabamus Soil and Water Conservation District <br />11. <br />Payee Tax IDif a licable 56-6000281 <br />12. <br />Record T e check : Grant: Cost Share: LJ Other: ❑ <br />13. <br />Staff Contact: Veronica Jamison I Phone: 919-707-3071 <br />14. <br />CRIS Program Name: 3341 <br />15. <br />16. <br />Division Contract # (optional): ADM-ADFP-1 8-006 <br />Project Title: Hill Farm +/- 59.26 Acres Perpetual Conservation Easement <br />17. Project County (list one county; if multiple counties, enter "Regional" and list counties on NC Openbook <br />Supplemental form; or list as "Statewide"): <br />Cabarrus <br />18.R <br />ion:n/a <br />19. <br />District #: n/a <br />20. <br />Project Start Date: October 1 2018 21. Project End Date: September 30, 2020 <br />If funding is from multiple sources, list each amount, cost center, and account. <br />22. <br />Grant Amount: $ 116 516.50 Grant Amount: $ Grant Amount: $ <br />23. <br />Cost Center. 2108-1012-2019 Cost Center. Cost Center: <br />24. <br />Account: 536406 Account: Account: <br />25. <br />Source: Federal: EJ State: ■ Fed/State: Other. LJ <br />26. Match Required: ■ Yes Amount: $17.477.48 (minimum <br />Record information on Trackin Form 1A'match as listed <br />reduired <br />match) No <br />by grantee <br />27. <br />Are Indirect Costs Allowable?LJ Yes % Rate: ■ No <br />28. <br />Cooperabve reement/FAIN #: n1a A#: <br />29. <br />Grantee Contact and Title: Daniel McClellan, Sr Resource Conservation Specialist <br />30. <br />Grantee Email: wdmcclellan cabarruscoun Phone: 704-920-3301 <br />31. <br />Offer to Division: 3/2/2018 <br />32. <br />Award to Division: <br />33. <br />Retainage n %of Total Contract Award Withheld: s23.ewa3 No <br />34.Equipment <br />in the Amount of $5,000 and Over to be purchased LJ Yes ■ No <br />35. <br />Tax Exempt Status Verified at Guidestar.or or IRS. ov - Initial & Date: VLJ 7/24/18 <br />36. <br />Federal Debarment Status Verified at SAM. ov - Initial & Date: VLJ7/24/18 <br />Grants & Contracts Section <br />Offer: <br />Award: Is the Grantee on the State's "Suspension of Funding List?' Yes ❑ No n/a <br />Tax Exempt Status Verified at Guidestar.org or IRS.gov - Initial & Date: n/a <br />Federal Debarment Status Verified at SAM.gov - Initial & Date: n/a <br />Eff: 7107; Rev: 7/14;1/17 <br />F-7 Page 116 <br />