2017-482-E Finance - Habitat for Humanity, Orange County, NC - Outside Agency Performance Agreement

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DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION ❑ ® c) Current beneficiaries of the program for which funds are being requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: 1/31/2017 Executive Director Date Signature: . {(A/4GbvL- lT 1/31/2017 Board Chairperson Date 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency(2 pages OR LESS): a) Years in Operation, Date of Incorporation (Month/Year): Habitat was incorporated on April 13, 1984. It has been in operation for 32 years. b) Agency's Purpose/Mission (no more than a few sentences): Habitat for Humanity of Orange County changes lives by bringing together God's people and resources to help families in need build and own quality affordable homes in safe and supportive communities. Habitat's vision is an Orange County where everyone has a decent place to live. c) Types of Services the Agency Provides (bullet format): • Habitat for Humanity of Orange County is a local nonprofit organization affiliated with Habitat for Humanity International (HFHI). Habitat provides affordable homeownership opportunities for families who live and/or work in Orange County, earn between 30% and 60% of the area DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page f of 1