2016-617-E Finance - United Way of the Greater Triangle - Outside Agency Performance Agreement

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DocuSign Envelope ID: 9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: United Way of the Greater Triangle Applicant Organization's Physical Address: 2400 Perimeter Park Drive, Suite 150, Morrisville NC 27560 Applicant Organization's Mailing Address: 2400 Perimeter Park Drive, Suite 150 Morrisville, NC 27560 Applicant Organization's Web Address: www.unitedwaytriangle.org Executive Director: Mack Koonce Telephone Number: 919 463-5010 E-Mail: mkoonce@unitedwaytriangle.org DUNS Number: 00-398-6184 (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) b) Project/Program Contact Information Project/Program Name: Orange County Food Policy Council Project/Program Primary Contact and Title: Molly De Marco Telephone Number: 919-966-9563 E-Mail: molly_demarco@unc.edu c) Funding Request Identification Total Project/Program Cost: $32,060, Total Amount of Funds Requested: $32,060 Proposed Use of Funds Requested (2-3 Line Maximum): Facilitation and development of the Orange County Food Policy Council Please check all types, sources, and amounts of funding being requested. You must submit an application package for each funding source. *The Participating Jurisdiction reserves the right to fund projects from any funding source, subject to eligibility and funding constraints. xHuman Services: x Carrboro $8,015 x Chapel Hill $9,618 x Orange County$14,427 d) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: /frr Signature: E, yD Date 05 z0 Board Chairperso Date Main Application 1/21/2016 1:05:37 PM Page 3