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17 <br /> Community Disclosure Report for Federally Assisted Projects <br /> Small Cities - • •ment Block Grant Program <br /> 1. Applicant/Recipient Name, 2. Check one: x Initial Report <br /> Address, and Phone: _ Update Report <br /> Orange County <br /> 131 West Margaret Lane <br /> Hillsborough, NC 27278 <br /> 919-245-2575 <br /> 3. Social Security Number or <br /> Employer ID Number: <br /> <br /> 4. Project Name and Location: <br /> Morinaga America Foods, Inc. Infrastructure <br /> Wilson Property—Accessed from Ben Wilson Road <br /> 5. Total Amount requested/received (including anticipated program income): $750,000 <br /> 6. Other Government Assistance. Check one: <br /> X No other government assistance is, or is expected to be, provided for this project. <br /> _All other government assistance provided for this project is listed on the attached page(s). <br /> 7. Interested Parties. Check one: <br /> X No parties have a reportable financial interest in this project. Interested parties include <br /> developers, contractors, consultants, individuals, entities including units of government with a <br /> financial interest greater than$50,000 or 10 percent of the assistance(whichever is lower; being <br /> a party to a contract procured under Federal procurement regulations at 24 CFR Part 85 does <br /> not, by itself, constitute a reportable financial interest). <br /> All parties with a reportable financial interest are listed on the attached page(s). <br /> 8. Other Government Assistance (Attachment) <br /> Note: Disclosures must be complete and accurate, but need be made only once for this report. <br /> If assistance is reported in the Sources and Uses disclosure section, then it need not also be <br /> reported here. If there is assistance reportable here, but reported only in the Sources and Uses <br /> disclosure, check here: <br /> Assistance is disclosed in Sources and Uses Attachments <br /> Amount <br /> Agency Name and Address Program and Type of Assistance Requested/Received <br /> 9. Certification: <br /> I hereby certify that all information in this report and its attachments is true and complete. <br /> Chair, Orange County Board of Commissioners Date <br /> CDBG-ED Disclosure Section 21 <br />