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DocuSign Envelope ID:9B26E979-2C09-4BE7-801C-3DDB484D92EE XHIBIT A <br /> PROVIDER"S OUTSIDE AGENCY APPLICATION <br /> 4. ATTACHMENTS <br /> a) Financial Audit <br /> New organization (Nov. 2, 2016 incorporated) <br /> b) IRS Federal Form 990 <br /> As a new organization, OCRA will submit an EZ990 postcard for 2016. <br /> c) NC Solicitation License <br /> Solicitation License Exemption has been applied for (application provided in attachments). <br /> Approval will be submitted when received. <br /> d) IRS Federal Tax-Exemption Letter <br /> A copy of the IRS Tax-exemption Letter is attached. <br /> e) Certificate of Liability Insurance <br /> Certificate attached <br /> e) List of Board of Directors <br /> NEED THIS LIST <br /> • Alex Castro Jr., Chair, 919 619-1510, 5915 Morrow Mill Road, Chapel Hill NC 27516, <br /> retired, 3 year term <br /> • Norma White, President, 919 732-8527, 4901 Schley Road, Hillsborough NC 27278, <br /> retired, 3 year term, <br /> • Archie Daniel, Vice President, 919 210-7876, 2110 Davis Drive, Hillsborough NC 27278, <br /> SALT Coordinator for OC Sheriff's Dept (Part-time), 3 year term <br /> • Bonnie Hauser, Treasurer, 919 732-9316, 4301 Sugar Ridge Road, Hillsborough, <br /> Retired, 3 year term <br /> • Karen Barrows, Secretary, 919 732-4491, 3816 Twin River Farm Road, Hurdle Mills <br /> 27541 <br /> f) Solid Waste Program Fee (SWPF) Verification <br /> OCRA does not have an office. The corporate office listed as 4901 Schley Rd, the private residence <br /> of Norma White. Letter certifying that SW fee is paid is provided. <br /> DO NOT SUBMIT THIS PAGE 2/8/2017 4:36:09 PM Page it • . "' ' <br />