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DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> 4. ATTACHMENTS <br /> Description of Required Attachments <br /> a) Financial Audit <br /> A recent financial audit that should cover CY 2015, for calendar year agencies, and FY <br /> 2015-16, for fiscal year agencies. <br /> b) IRS Federal Form 990 <br /> A copy of the agency's 2014 Form 990 is required. <br /> c) NC Solicitation License <br /> A copy of the agency's current solicitation license is required. <br /> d) IRS Federal Tax-Exemption Letter <br /> A copy of the agency's IRS tax-exempt letter that confirms its nonprofit status is required. <br /> e) Certificate of Liability Insurance <br /> f) List of Board of Directors <br /> Provide the following information about each board of director's member: name, telephone <br /> number, address, occupation or affiliation of each member and the list must identify the <br /> principal officers of the governing body, and length of term. <br /> g) Solid Waste Program Fee (SWPF) Verification <br /> This fee finances Orange County's recycling and waste reduction program. Submit either a.) <br /> proof of payment of the agency's FY 2016-17 Solid Waste Program Fee, OR b.) a statement <br /> on agency letter head indicating exemption and specify the person(s), business, etc. that is <br /> responsible for paying this fee. <br /> DO NOT SUBMIT THIS PAGE 1/31/2017 3:16:25 PM Page 32 of 32 <br />