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DocuSign Envelope ID: A0992361- 7662- 4FD7- 9DB3- 9D760E06A5D2 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />h) Agency Budget <br />i. 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, Chapel Hill, <br />and Orange County governments (other than Human Services). DO NOT include federal <br />funding sources, such as CDBG and HOME. <br />Program <br />FY17 -18 <br />Award <br />FY18 -19 <br />Request <br />Source <br />Orange County — Mail Services <br />$52380.00 <br />$52380.00 <br />Orange County <br />Orange County Library — Janitorial <br />Services <br />$1140.00 <br />$1140.00 <br />Orange County <br />Guardian Ad Litem Offices - Janitorial <br />Services <br />$2600.00 <br />$2600.00 <br />Orange County <br />Solid Waste - Janitorial Services <br />$18516.00 <br />$18516.00 <br />Orange County <br />Cedar Grove Community Center/ Efland <br />Cheeks Community Center Janitorial <br />Services <br />$33512.64 <br />$33512.64 <br />Orange County <br />*Add rows or attach additional page, if needed. <br />Agency Information 1/22/2018 1:53:42 PM P a g e 7 o f 18 <br />