Orange County NC Website
ATTACHMENT A <br /> 9 <br /> ATTACHMENT "A" <br /> Orange County Certifications —FY 2010 <br /> Outside Agency Performance Agreement <br /> Chief Contact,Administrators, chief Executive officer and chief Financial officer <br /> I certify that I have provided a list of the chief contact, administrators, chief executive officer <br /> and chief financial officer for my agency with this Agreement and that I will keep it current <br /> to the County of orange. The list should be in writing with the name, title,residential <br /> address;phone and email address and if possible, fax number. <br /> Officers and Board of Directors <br /> I certify that I have provided a current list of the officers and Board of Directors with this <br /> Agreement and that we will continue to update the list as changes occur. The list should be <br /> in writing,with the name, physical address,mailing address and if possible,phone, fax and <br /> email address. <br /> Budget Submission <br /> I certify that I have provided a budget for the period to be covered by funding orange <br /> County, and that any substantive changes made to this budget have been in advance <br /> authorized in writing by orange County. <br /> Annual Financial Review <br /> I certify that I have provided a copy of the latest annual Financial Review for our agency <br /> and the budget adopted by the agency for the fiscal years encompassing this Agreement. If <br /> not,please explain on a separate sheet of paper. <br /> Alignment with Organization's Mission <br /> I certify that the programs and services for which this funding is requested align with the <br /> mission of the organization. <br /> Intended Purpose <br /> I certify that the funds provided to the agency under the terms of this Agreement will be <br /> used for a public purpose and shall only be used for the purposes intended and any money <br /> not used for those purposes will be promptly returned to orange County. <br /> Certified by: Title: Date: <br /> (Ageng Name) <br /> grange County autlide Ageng Performance Agreement <br /> Page 8of8 <br /> Page 9 of 26 <br /> Allocation<$10,000 <br />