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DocuSign Envelope ID:8A1AB1 BF-ACDB-42A1-A3DE-9E9549E569B4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Section III. Program Information <br /> Program Budget Worksheet <br /> AGENCY NAME: Farmer Foodshare <br /> Actual Estimated Projected Percent <br /> PROGRAM REVENUE 2015-16 2016-17 2017-18 Change <br /> Private Donations $ 21,000 $ 25,399 $ 42,033 65% <br /> Program Generated Revenue(fees) $ - $ - $ 500 0 <br /> Local Government Grants: <br /> Orange County $ 5,000 $ 5,000 $ 10,000 100% <br /> Town of Chapel Hill $ 2,500 $ 2,500 $ 5,000 100% <br /> Town of Carrboro $ 1,500 $ 2,500 $ 5,000 100% <br /> Other Local: 0 <br /> Other Local: 0 <br /> Other Local: 0 <br /> If more than 3 sources,please provide <br /> a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way 0 <br /> State Government 0 <br /> Federal Government 0 <br /> Other Grants: Private Foundation $ 26,000 $ 30,000 $ 11,000 -63% <br /> Other Grants: 0 <br /> Miscellaneous/Other Revenue $ 10,000 $ 10,500 $ 11,700 11% <br /> Please list 3 largest Miscellanous sources: <br /> sponsorships and business support $ - $ 10,000 $ 10,500 $ 11,700 <br /> $ - <br /> Total Program Revenue $ 66,000 $ 75,899 $ 85,233 12% <br /> PROGRAM EXPENSES <br /> Compensation $ 48,000 $ 55,959 $ 61,568 10% <br /> Rent& Utilities $ 5,000 $ 5,000 $ 5,960 19% <br /> Supplies & Equipment $ 7,500 $ 8,630 $ 10,285 19% <br /> Travel &Training $ 5,500 $ 6,310 $ 7,420 18% <br /> Other Expenses: $ - $ - 0 <br /> Please list 3 largest"Other Expenses": <br /> $ <br /> $ <br /> $ - <br /> Total Program Expenses $ 66,000 $ 75,899 $ 85,233 12% <br />