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SUBMISSION CHECKLIST <br />Primary Applicant Organization Chapel Hill-Carrboro Branch of the NAACP _ <br />Project Name(s) ___Water Heater Replacement _________ <br />Section Subsection <br /> Cover Page Applicant and Collaborator/Partner Contact Information <br /> Funding Requests <br /> Signed Application Cover Page <br /> Signed Disclosure of Conflicts of Interest and Clause <br /> <br />Applicant Information Applicant organization’s Date of Incorporation <br /> Applicant organization’s Purpose/Mission (if applicable) <br /> Living Wage <br /> Schedule of Positions (if applicable) <br />Project Information Project Name <br /> Project Description <br /> Strategic Objective <br /> Target Population <br /> Performance Indicators <br /> Project Budget Summary <br /> Attachments <br />(A description of these items <br />is available on page 15: <br />“Description of Required <br />Attachments.” Please <br />contact us if it will not be <br />possible to provide any <br />of these required <br />attachments at the time <br />of application: <br />bbouma@orangecountyn <br />c.gov) <br /> Applicant Organization’s Annual Budget and Proposed <br />Project Budget (Use template provided) <br /> Applicable Financial Records to prove eligibility: IRS <br />Federal Form 990 or Applicant Organization’s Tax Returns <br />from 2019 <br /> Applicable Financial Records to prove eligibility of <br />collaborator/partner (if they are receiving project funds): IRS <br />Federal Form 990 or Tax Returns from 2019 <br /> List of members of organization’s Governing Board (if <br />Board exists) <br /> Solid Waste Program Fee (SWPF) Verification (for <br />commercial property owners and renters) <br /> Certificate of Insurance <br />P a g e 5 o f 23 <br />DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134