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DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E <br /> DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON-DISCRIMINATION CLAUSE <br /> Are any of the Board Members or employees of the agency which will be carrying out this program or <br /> members of their immediate families,or their business associates. <br /> YES NO <br /> YES a) Employees of or closely related to employees of the Town of Carrboro, the Town of <br /> Chapel Hill,or Orange County? <br /> NO 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 /> NO C) Current beneficiaries of the program for which funds are being requested? <br /> NO d) Paid providers of goods or services to the program or having other financial interest in <br /> the program? <br /> If you have answered YES to any question, please provide a full explanation below. <br /> Board Member Jabe Hunter is employed by the Chapel Hill Police Department but he <br /> does not receive any financial benefits from serving on EmPOWERment, Inc's Board of <br /> Directors. Mr. Hunter's job as Assistant Chief of Police does not pose a conflict of interest <br /> with El providing affordable rental units. <br /> NON-DISCRIMINATION <br /> Provider agrees as part of consideration of the granting of funds by funding agencies to the parties <br /> hereto for themselves,their agents, officials, employees and servants agree not to discriminate in <br /> any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual <br /> orientation, gender identity/expression, familial status or veterans status with reference to any <br /> activities carried out by the grantee,no matter how remote.The parties hereto further agree in all <br /> respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as <br /> amended and the Orange County Anti-discrimination Policy.This provision is enforced by action for <br /> specific performance, injunctive relief, or other remedy as by law provided; this provision shall be <br /> binding on the grantees, the successors and assigns of the parties hereto with reference to the <br /> above subject manner. <br /> To the best of my knowledge and belief all of the above information is true and current. I <br /> acknowledge and understand that the existence of a potential conflict of interest does not <br /> necessarily make the program ineligible for funding, but the existence of an undisclosed <br /> conflict may result in the termination of any grant awarded. <br /> Signature: 13 <br /> Executive Director Date <br />