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DocuSign Envelope ID:ODO4B5DD-363F-41 FF-BD24-FAD291133B51 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 4. Attachments a. ❑Audit: Organizations receiving $300,000 or more in Federal <br /> financial assistance, and/or organizations with more than $500,000 <br /> of receipts and expenditures in a fiscal year, must secure an audit. <br /> b. ❑ IRS Federal Form 990 <br /> c. ❑ NC Solicitation License <br /> d. ❑ IRS Federal Tax-Exemption Letter <br /> e. ❑ Certificate of Insurance <br /> f. ❑ List of Board of Directors <br /> g. ❑ Solid Waste Program Fee (SWPF)Verification <br /> DO NOT SUBMIT THIS PAGE 12/15/2016 9:57:17 AMII'age 7 ,r 32 <br />