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DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 4. Attachments a. El 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. E] IRS Federal Form 990 <br /> c. LI NC Solicitation License <br /> d. El IRS Federal Tax-Exemption Letter <br /> e. El Certificate of Insurance <br /> f. El List of Board of Directors <br /> g. El Solid Waste Program Fee (SWPF)Verification <br /> Application Submittal Checklist 1/27/2017 1 :43:18 PM Page 6 of 2 <br />