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DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 24 CFR 570.200(a), <br /> 4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 208, <br /> each expenses for the entire program and ALL sources of 507.503 <br /> program/ funding. 24 CFR 570.506, <br /> project for 570.507, 570.601, <br /> which funding a. ® Program Budget Worksheet 570.602, 570.607(b), <br /> is requested) b. ® Program Budget Detail 570.611 <br /> 24 CFR <br /> c. ® Cost Per Unit 570.502-570.504, <br /> d. ® Agency Operating Budget Worksheet 570.506, <br /> 570.507, 570.610; 24 <br /> CFR Parts 84 or 85, and <br /> OMB Circulars A-87 or A- <br /> 122; <br /> Treasury Circular 1075 <br /> 5. Supplemental A. ❑ Part A: CDBG & HOME <br /> Sections (as B. ❑ Part B: Construction/Rehab <br /> applicable) <br /> 6. Attachments a. ® Audit: Organizations receiving $300,000 or more OMB Circular A-133 <br /> in Federal financial assistance, and/or organizations <br /> with more than $500,000 of receipts and <br /> expenditures in a fiscal year, must secure an audit. <br /> b. ❑ IRS Federal Form 990 <br /> c. ❑ NC Solicitation License* <br /> d. ® IRS Federal Tax-Exemption Letter <br /> e. ® Certificate of Insurance <br /> f. ® List of Board of Directors 24 CFR Parts 84 or 85 <br /> g. ® Articles of Incorporation/Bylaws 24 CFR 570.208, <br /> h. ® Authorization to Request Funds 570.500(c), 570.611 <br /> i. ® Authorized official designation <br /> j. ❑ Solid Waste Program Fee (SWPF) Verification** <br /> *Volunteers for Youth has a 2/15/16 extension on its solicitation license. We will send it as <br /> soon as it is received. <br /> **Volunteers for Youth rents an office in a building owned by David Ontjes, who is <br /> responsible for paying the Solid Waste Program Fee. <br /> Main Application 5/25/2016 10:34:40 AM 0 I:° 2 of 25 <br />