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DocuSign Envelope ID: 1056F994-88AA-4336-8102-E1F3178D3BE7 <br /> AGENCY INFORMATION <br /> Please provide the following information about your agency: <br /> 1. Date of Incorporation (Month/Year): 0511981 <br /> 2. Agency's Purpose/Mission (no more than a few sentences): To minister to the urgent needs of citizens of <br /> northern Orange County through the volunteer efforts of diverse congregations And individuals inspired <br /> by faith in God, and to enhance self-sufficiency and awareness of community resources. <br /> 3. Please provide a brief description of your organization's past achievements in carrying out similar <br /> projects and evidence of successful record of meeting proposed budgets and timetables(no more than <br /> 100 words). For the past 37 years, with the help of a supportive community and dedicated volunteers, <br /> OCIM has maintained a reputation of quick and compassionate responses to the human creeds in Orange <br /> County.As per Orange County quarterly reports, every effort is made to spend Orange County funds in the <br /> manner intended, in the time frame intended. Through new partnerships with Orange County's Family <br /> Success Alliance and Department of Social Services(Rent and Water bills)we routinely meet the goals and <br /> terms of record keeping and Budgetary requirements. <br /> 4. Living Wage: Does this agency pay permanent employees a minimum living wage?(Yes/No) yes <br /> If yes,is this agency an Orange County Living Wage Certified Employe ? No <br /> if no, please briefly explain. We have not submitted an application. <br /> Schedule of Positions: #of FTE—Full-Time Paid Positons: —7_ #of FTE—Part-Time Paid Positions:_4— <br /> PROGRAM INFORMATION <br /> *Please submit for each program if applying for funding for more than one program. <br /> 5. Program Name: Samaritan Relief Ministry <br /> Program Primary Contact and Title: Kay 5tagner <br /> Telephone Number: 919-732-6194 ex. 12 E-Mail: ocimsrm@embargmail.com <br /> 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of <br /> Cha Pel Hill and Carrboro's Results Framework and Oran ge Cc u rty BOCC Goals and Priorities and the target <br /> population to benefit from the program. (100 words or less) The Samaritan Relief Ministry provides <br /> groceries and financial assistance for rent, utilities, and prescription medication for families and individuals <br /> living in northern Orange County; the geographical boundaries of the Orange County School District. This <br /> — .. ...................................-......... .......... <br /> Program information P a g e 7 o F 2 0 <br />