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2017-584-E Finance - Orange Congregations in Mission - Outside Agency Performance Agreement
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2017-584-E Finance - Orange Congregations in Mission - Outside Agency Performance Agreement
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Last modified
7/23/2019 12:19:42 PM
Creation date
10/23/2017 4:06:13 PM
Metadata
Fields
Template:
Contract
Date
7/1/2017
Contract Starting Date
7/1/2017
Contract Ending Date
6/30/2017
Contract Document Type
Agreement - Performance
Agenda Item
6/20/17
Amount
$71,415.00
Document Relationships
R 2017-584-E Finance - Orange Congregations in Mission - Outside Agency Performance Agreement
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\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2017
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DocuSign Envelope ID:71415AD7-DCDD-4CF6-89A9-F93F72D8DC62 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> c) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AN' NON DISCRIML ATION <br /> CLAUSE <br /> Are any of the Board Members or employees of the agency which will be carrying out this program <br /> or members of their immediate families, or their business associates... <br /> YES NO <br /> LI X a) Employees of or closely related to employees of the Town of Carrboro, the Town of <br /> Chapel Hill, or Orange County? <br /> El X b) Members of or closely related to members of the governing bodies of the Town of <br /> Carrboro, the Town of Chapel Hill, or Orange County? <br /> c) Current beneficiaries of the program for which funds are being requested? <br /> L] X d) Paid providers of goods or services to the program or having other financial interest in the <br /> program? <br /> If you have answered YES to any question, please provide a full exslanation below. <br /> NON-DISCRIMINATION <br /> Provider agrees as part of consideration of the granting of funds by funding agencies to the <br /> parries nerero for rnemseives, mew agents, =oafs, employees and servants agree not to <br /> discriminate in any manner of these basis of race, color, gender, national origin, age, <br /> handicap, religion, sexual orientation, gender identity/expression, familial status or veterans <br /> status with reverence to any activities carried out by tne grantee, no matter now remote. I ne <br /> parties hereto further agree in all respects to conform to the provision and intent of Orange <br /> County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination <br /> eoricy. This provision is enforced by action for specific performance, injunctive relief, or other <br /> remedy as by law provided; this provision shall be binding on the grantees, the successors <br /> and assigns of the parties hereto with reference to the above subject manner. <br /> To the best of y knowledge and belief 11 of the above information is true and <br /> current. I acknowledge and understand that the existence of a potential conflict of interest <br /> does not necessarily make the program ineligible for funding, but the existence of an <br /> undisclosed conflict may result in the termination of any grant awarded. <br /> Signature:(legy.) ,1-4,1497, p p,21) 1 / <br /> E cutive Director Date <br /> Signature: i <br /> Board Chairperson Date <br /> AGENCY INFORMATION 1/28/2017 11:12:49 AM Page 8 o 1 23 <br />
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