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DocuSign Envelope ID:6D821DA0-CO6F-4D38-BB4F-DB28CB54AD8E XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> h) Agency Budget <br /> Is your agency currently receiving and/or requesting other (non-Human <br /> Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) <br /> government funding? (Yes/No) No <br /> If yes, please list below: <br /> Include all programs that have funding requests/awards/totals from Carrboro, <br /> Chapel Hill, and Orange County governments (other than Human Services). DO <br /> NOT include federal funding sources, such as CDBG and HOME. <br /> Program FY16-17 FY17-18 Source <br /> Award Request <br /> Orange County — Mail $52,380 $52,380 Orange County <br /> Services <br /> Orange County Library — $1,140 $1,140 Orange County <br /> Janitorial Services <br /> Guardian Ad Litem Offices - $2,400 $2,400 Orange County <br /> Janitorial Services <br /> Solid Waste - Janitorial $11,400 $11,685 Orange County <br /> Services <br /> Cedar Grove Community $33,512.64 $33,512.64 Orange County <br /> Center/ Efland Cheeks <br /> Community Center Janitorial <br /> Services <br /> *Add rows or attach additional page, if needed. <br /> Agency Information 1/31/2017 8:24:51 AM II ' ago f 20 <br />