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DocuSign Envelope ID: EB541A3B-1E01-49AB-9E09-7987ECAEC1C4 [ A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> d. Agency Operating Budget Worksheet 570.502-570.504, <br /> 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. E] Part A: CDBGXOME <br /> Sections (as B. Ei Part B: Constr c 'on/Rehab <br /> applicable) <br /> 6. Attachments a. 121tudit: 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 /> expe, :itures in a fiscal year, must secure an audit. <br /> b. E IRS Federal Form 990 <br /> c. IIV, Solicitation License <br /> d. 1E7/ S Federal Tax-Exemption Letter <br /> e. n C"tificate of Insurance <br /> f. E./46i of Board of Directors 24 CFR Parts 84 or 85 <br /> g. Dr(ic -s of Incorporation/Bylaws 24 CFR 570.208, <br /> h. A ithorization to Request Funds <br /> TiyA -- <br /> 570.500(c), 570.611 <br /> I. II A horized official designation <br /> j. Solid Waste Program Fee (SWPF) Verification <br /> Main Application1/25/2016P a g e 2 of 32 <br />