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DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 1. Submit your program budget. You may complete the provided template (separate xis <br /> file) or you may submit your own budget file (as long as it contains the same information, <br /> in the same format, as requested in the provided template). <br /> Agency Budget <br /> Operating Budget for Entire ency <br /> AGENCY NAME: Historic Hillsborough Commission <br /> 11 Actual Estimated Projected Percent <br /> AGENCY REVENUE 2015-16 2016-17 2017-18 Change <br /> Private Donations $ 8,000 $ 10.000 $ 11,000 10% <br /> Agency Generated Revenue(fees) $ 20,078 $ 25.000 $ 25.000 0% <br /> Local Government Grants: <br /> Human Services-Town of Carrboro $ - $ - $ - <br /> Other-Town of Carrboro $ - $ - $ - 0 <br /> Human Services-Town of Chapel Hill $ - $ - $ - 0 <br /> Other-Town of Chapel Hill $ $ $ . 0 <br /> Human Services-Orange County $ 7,000 $ 8.857 $ 10.000 13% <br /> Other-Orange County $ - $ - $ 0 <br /> Other-Town of Hillsborough $ 16.000 $ 20.787 $ 20,787 0% <br /> Other Government Grants <br /> Triangle United Way - $ - $ - 0 <br /> State Government - $ - $ - 0 <br /> Federal Government (COBG/HOMIEletc.) $ - $ - $ 0 <br /> Private Foundation Grants Kirby $ 7500,00 $ 10,000,00 $ - $ 1,00)1 <br /> Other Revenue 0 <br /> Total Agency Revenue $ 66,950 $ 69,000 $ 69,500 1% <br /> AGENCY EXPENSES <br /> Compensation $ 34.000 $ 45,000 11 $ 46.650 4% <br /> Rent&Utilities $ 6.350 $ 6,000 $ 6.100 2% <br /> Supplies&Equipment $ 3,500 $ 3,500 $ 3.500 0% <br /> Travel& Training $ - $ - $ 01 <br /> Other Expenses: $ 24,500 $ 23 500 $ 22,000 I -6% <br /> Total Agency Expenses $ 68,350 $ 76,500 $ 78,250 2% <br /> SURPLUS/(DEFICIT)FOR PERIOD: $ (1,400)1 $ (7,5001$ (8,750)1 -17% 1 <br /> Program Budgets are required to define budget amounts for the previous program <br /> year, current program year, and next program year for the following categories: <br /> • Revenues <br /> o Private Donations <br /> O Program Generated Revenue <br /> a Local Government Grants <br /> • Carrboro Human Services <br /> • Carrboro Other <br /> PROGRAM INFORMATION 1/31/2017 4:15:48 PM I°' a q e 8 c) 1 22 <br />