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DocuSign Envelope ID: D9639255-8147-4A2F-A760-941BDE078E48 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Section VI.Financial Data <br /> Operating Budget for Entire Agency <br /> AGENCY NAME: Triangle Bikeworks <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change <br /> Private Donations $ 31,798 $ 20,000 $ 22,000 10% <br /> Agency Generated Revenue(fees) $ 2,000 $ 2,000 0% <br /> Local Government Grants: <br /> Orange County $ 1,250 $ 1,000 -20% <br /> Town of Chapel Hill $ 1,250 $ 1,250 0% <br /> Town of Carrboro $ 1,250 $ 1,250 0% <br /> Other Local: 0 <br /> Other Local: 0 <br /> Other Local: 0 <br /> If more than 3 sources,please <br /> provide a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way $ - $ - $ - 0 <br /> State Government $ - $ - $ - 0 <br /> Federal Government $ - $ - $ - 0 <br /> Other Grants: $ - $ - $ - 0 <br /> Other Grants: $ - $ - $ - 0 <br /> Miscellaneous/Other Revenue $ 9,500 $ 2,500 $ 2,750 10% <br /> Please list 3 largest Miscellanous sources: <br /> IBM Community Grant $ 2,500.00 <br /> Earwheels Bike Club(restricted $ 2,500.00 <br /> DHC Youth Forward(restricted $ 4,500.00 <br /> Total Agency Revenue $ 41 298 $ 28 250 $ 33 250 18% <br /> AGENCY EXPENSES <br /> Compensation $ - $ - $ - 0 <br /> Rent&Utilities $ 4,050 $ 3,000 $ 3,300 10% <br /> Supplies&Equipment $ 927 $ 1,000 $ 1,100 10% <br /> Travel&Training $ 247 $ 750 $ 825 10% <br /> Other Expenses: $ 13,940 $ 13,940 $ 15,334 10% <br /> Please list 3 largest"Other Expenses": <br /> Contract Services $ 3,993.00 <br /> Facilities and Equipment $ 3,936.00 <br /> Insurance and Other Expenses $ 6,011.00 <br /> Total Agency Expenses $ 19,164 $ 18,690 $ 20,559 10% <br /> SURPLUS/(DEFICIT)FOR PERIOD: I$ 22,134 I$ 9,560 I$ 12,691 I 33/ <br /> Main Application 5/25/2016 10:17:47 AM P o of 2 <br />