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DocuSign Envelope ID:9DA2D4AC-2348-434E-9B84-9BF3524778E5 <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 /> ® ❑ a) Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill, <br /> or Orange County? <br /> ® ❑ b) Members of or closely related to members of the governing bodies of the Town of Carrboro,the <br /> Town of Chapel Hill,or Orange County? <br /> ® ❑c)Current beneficiaries of the program for which funds are being requested? (NC PreK classrooms <br /> will be a focus of activity.) <br /> ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the <br /> program? <br /> If you have answered YES to any question,please provide a full explanation below. <br /> Board member Lucinda Munger leads the Orange County Library; Board member Quintana <br /> Stewart leads the Orange County Health Department; Sue Florence is associated with the <br /> Cedar Grove Community Center, a county facility. Orange County Commissioner Jamezetta <br /> Bedford is a board member, appointed by the County Commissioners to the OCPYC Board <br /> of Directors, and Matt Hughes, who serves on the Hillsborough Board of Commissioners, is <br /> a board member. Kerry Moore, director of CHCCS Head Start and Pre-K, and Adriana <br /> Martinez, director of Spanish for Fun Academy, provide NC Pre-K services. <br /> NON-D1SCRI[MiNATION <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 any <br /> manner of these basis of rate,color,gender,national origin,age,handicap,religion,sexual orientation, <br /> gender identity/expression,familial status orveterans status with reference to any activities carried out <br /> by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to <br /> the provision and intent of Orange County Civil Rights Ordinance,as amended and the Orange County <br /> Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive <br /> relief,or other remedy as by law provided;this provision shall be binding on the grantees,the successors <br /> and assigns of the parties hereto with reference to the above subject manner. <br /> C;o,,er Pa.;p P a g e 4 o 1 16 <br />