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Are any of the Board Members or employees of the agency which will be carrying out this project, or <br />members of their immediate families, or their business associates: <br />a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, <br />Carrboro, or Hillsborough? YES ❑ NO ❑ <br />b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, <br />Hillsborough, or Orange County? YES ❑ NO ❑ <br />c) Current beneficiaries of the project /program for which funds are requested? <br />YES ❑ NO ❑ <br />d) Paid providers of goods or services to the program or having other financial interest in the <br />program? YES ❑ NO ❑ <br />If you have answered YES to any question, please provide a full explanation below. The existence of a <br />potential conflict of interest does not necessarily make the project ineligible for funding, but the <br />existence of an undisclosed conflict may result in the termination of any grant awarded. <br />Page 9 of 9 <br />