2018-637-E Finance - Youth Community Project outside agency agreement

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DocuSign Envelope ID:3457204A-7765-4E36-8B42-227F6F673AF6 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 4. ATTACHMENTS Description of Required Attachments a) Financial Audit A recent financial audit that should cover CY 2015, for calendar year agencies, and FY 2015- 16, for fiscal year agencies. For agencies with prior year revenues totaling $500,000 or more a financial audit, prepared by a certified public accountant is required. Agencies with prior year revenues of less than $500,000 may submit a completed Schedule of Receipts and Expenditures form (see application materials), in lieu of an audit/report. Agencies with a certified audit/report should not complete the form. b) IRS Federal Form 990 A copy of the agency's 2014 Form 990 is required. The specific form depends upon the agency's financial activity. Review the IRS' table guide, for more details. For Form 990-N (e- postcard) filers, include a copy of the postcard, with the agency's application materials. c) NC Solicitation License A copy of the agency's current solicitation license is required. Organizations that solicit contributions in North Carolina, directly or through a third party, must renew their licenses annually. For more details, refer to the NC Secretary of State's licensing website and its Frequently Asked Questions Guide (PDF), about exemptions. If exempt per N.C.G.S. § 131 F- 3, include a copy of the exemption letter with the agency's application materials. *** 2017 Reapplication Submitted to NC Secretary of State 01/31/2017. d) IRS Federal Tax-Exemption Letter A copy of the agency's IRS tax-exempt letter that confirms its nonprofit status is required. An agency can request a copy of its letter from the IRS' Customer Account Services. e) Certificate of Liability Insurance *** The Youth Community Project has experienced difficulties in securing liability insurance because of its need for coverage of its aerial arts program when conducting events out in the community (i.e., not within venues that routinely sponsor aerial arts and already covered by appropriate insurance). YCP has worked with Dominick, Huckabee, Noblin & Trent and the broker Atlantic Specialty to secure a new insurance policy meeting the towns' and county's requirements and will be covered by February 3, 2017 for the coming year. Offsite aerial events will henceforth be conducted only with acquisition of event specific insurance. The new certificate of insurance will be forwarded immediately upon receipt by YCP from the carrier. DO NOT SUBMIT THIS PAGE 1/31/2017 12:37:26 PM Page 43 of 45