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DocuSign Envelope ID: E7F88FC1-7C61-4E68-8AF9-5870F711DEBC it A continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> 24 CFR 570.200(a), <br /> 4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 206, <br /> each expenses for the entire program and ALL sources of 507,503 <br /> program/ funding, 24 CFR 570.506, <br /> project for 570.507, 570.601, <br /> which funding a. ® Program Budget Worksheet 570.602, 570.607(b), <br /> is requested) b. ® Program Budget Detail 570.611 <br /> c. Cost Per Unit 24 CFR <br /> d. Agency Operating Budget Worksheet 570,502-570.504, <br /> 570.506, <br /> 570.507, 570.610; 24 <br /> CFR Parts 84 or 85, and <br /> OMB Circulars A-87 or A <br /> 122; <br /> Treasury Circular 1075 <br /> 5. Supplemental A. Part A: CDBG $ HOME <br /> Sections (as B. ® Part B: Cons tructionlRehab <br /> applicable) <br /> 6. Attachments a. ® Audit. Organizations receiving $300,000 or more OMB Circular A-133 <br /> in Federal financial assistance, and/or organizations <br /> with more than $500,000 of receipts and <br /> expenditures in a fiscal year, must secure an audit. <br /> b. IRS Federal Form 990 <br /> c. NC Solicitation License <br /> d. IRS Federal Tax-Exemption Letter <br /> e. Certificate of Insurance <br /> f. List of Board of Directors 24 CFR Parts 84 or 85 <br /> g. ® Articles of Incorporation/Bylaws <br /> 24 CFR 570.208, <br /> h. Z Authorization to Request Funds 570.500(c), 570.611 <br /> i. Z Authorized official designation <br /> j. E Solid Waste Program Fee (SWPF) Verification <br /> Main Application 1/25/201 6 1:23:46 PM P �1 , c, 2 n f 2 6 <br />