Orange County NC Website
Browse       Search
DocuSign Envelope ID:ODO4B5DD-363F-41 FF-BD24-FAD291133B51 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION <br /> CLAUSE <br /> Are any of the Board Members or employees of the agency which will be carrying out this program or <br /> members of their immediate families, or their business associates... <br /> YES NO <br /> YES a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel <br /> Hill, or Orange County? <br /> YES b) Members of or closely related to members of the governing bodies of the Town of Carrboro, <br /> the Town of Chapel Hill, or Orange County? <br /> NO c) Current beneficiaries of the program for which funds are being requested? <br /> NO d) Paid providers of goods or services to the program or having other financial interest in the <br /> program? <br /> If you have answered YES to any question, please provide a full explanation below. <br /> Mark Marcoplos is an Orange County Commissioner and as such is a salaried employee of Orange <br /> County. <br /> NON-DISCRIMINATION <br /> Provider agrees as part of consideration of the granting of funds by funding agencies to the <br /> parties hereto for themselves, their agents, officials, employees and servants agree not to <br /> discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, <br /> religion, sexual orientation, gender identity/expression, familial status or veterans status with <br /> reference to any activities carried out by the grantee, no matter how remote. The parties hereto <br /> further agree in all respects to conform to the provision and intent of Orange County Civil Rights <br /> Ordinance, as amended and the Orange County Anti-discrimination Policy, This provision is <br /> enforced by action for specific performance, injunctive relief, or other remedy as by law provided; <br /> this provision shall be binding on the grantees, the successors and assigns of the parties hereto <br /> with reference to the above subject manner. <br /> To the best of my knowledge and belief all of the above information is true and current. <br /> I acknowledge and understand that the existence of a potential conflict of interest does not <br /> necessarily make the program ineligible for funding, but the existence of an undisclosed <br /> conflict may result in the termination of any grant awarded. <br /> DO NOT SUBMIT THIS PAGE 12/15/2016 9:57:17 AMPage 10 of 31 <br />