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DocuSign Envelope ID:B701CF6A-1C9A-46CB-9234-56F771D80955 continued <br /> Providet% rciabn4, ittit*Appli cation <br /> 10 1. „•S1..?RE * 1 *TENWLC. FLIC S OF I EST <br /> Are arhoi info RJ ihidlernhers or employees of th e: agarley urruenn,:un be carrying out this project or <br /> MOM 1;':Ulueurus of Pleb immediate families, or their besino rs nisseciaiese <br /> YES <br /> Fi tJ ErriolOyees of ;or closely related to employees of the Town of Chapel Hill, Orange <br /> County, Carrhoro, o HilabOnnagn? <br /> d) Members of or clOSely reistob to members of the preventing bodies of Cheorel Hili, <br /> Carthrere, iiiiilsbora gh, or Orange COL nty? <br /> d) Current den efibanes of the proleribUoirop ram for which fonds are ran nested? <br /> Ej la) Paid providers of goods or services to the program or raving other firiancial rraanausi in <br /> the po& ani? <br /> you have answered YES to any question, please provide a full explanatiev below. <br /> To the best of my knowteioge ap,,d belief all of th ei. vc information is true <br /> current. I acknowii,*ge and un, Herstand that the existe, cc rir potential corneflict of i.I.,)terrest <br /> does het nocessariiy ,linake the project ineiigible for f nih , but the oeogsteir rree Of an <br /> 11,11diSuclOSued POP u filet nee„. result in the termination of n trent imarleti., <br /> 5igned lba Bryan A,%Auffman <br /> cAl=faryian A.Hulfirina /A=Wil C A uf the yk!, <br /> ry , A..A try ou—C,had mare.hn affair <br /> A. „ " - <br /> ern d krBrydn.Hurfa II u ru ?MCA Tri m gle.0 g <br /> Dee:2011,6.01.21 000602-0.5'012 <br /> Sign t lure; <br /> Chief liinitincial OffiCaur Data <br /> ,uu , <br /> ) u„) <br /> r.74 I 4,"'■ <br /> Signetarer <br /> Boornelkanii, BoarCiPireisidetyt) <br /> (115 <br /> raise Appanation 12 2 1 12 C ','.urur34,,,b4 uU <br />