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DocuSign Envelope ID:650510CC-1 E40-4E7E-A21 D-3B96055FB69D <br /> COVER PAGE 7771 <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name: Orange County Living Wage <br /> Applicant Organization's Physical Address: 218 Lake Manor Road, Chapel Hill, NC 27516 <br /> Applicant Organization's Mailing Address: P.O. BOX 1502, Carrboro, NC, 27510 <br /> Applicant Organization's Web Address: www.orangecountylivingwape.org <br /> Executive Director:Susan Romaine <br /> Telephone Number: (919) 619-3408 E-Mail: susan(@orangecountylivingwage.org <br /> Tax ID Number:47-4595087 <br /> Funding Request <br /> Please list all Fiscal-Year 2021 Human Services (HS)funding requested for all programs and the proposed <br /> use of funds(please list program name only) <br /> Program Carrboro-HS Chapel Hill-HS Orange Total <br /> County-HS <br /> Living Wage Certification Program $1,000 $3,000 $25,000 $29,0000 <br /> Program Supplies Website/lob Personnel/ <br /> Board Operations <br /> Totals $1,000 $3,000 $25,000 $29,0000 <br /> Briefly explain your proposed use of funds: <br /> Funds will be used to: <br /> • Maintain OCLW's website and social media presence <br /> Add a new job board listing job openings for certified living WdeU employers <br /> • Purchase program supplies and marketing materials for certified employers <br /> 0 Compensate OCLW's certification coordinator, administrative assistant, and <br /> communications Specialist. <br /> To the best of my knowledge and belief all information and data in this application is true and current. <br /> The document has been duly authorized by the governing board of the applicant. <br /> Signature: <br /> Executive Director Date <br /> f <br /> i <br /> Signature: "I�t, '? ��_SYV��`�'zt,'It�, <br /> Board Chairperson Date <br />