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COVER PAGE <br />Applicant Contact Information <br />Applicant Organization’s Legal Name: Chapel Hill-Carrboro Branch of the NAACP <br />Applicant Organization’s Physical Address: 891 Willow Drive Suite #7, Chapel Hll, NC <br />27514 <br />Applicant Organization’s Mailing Address: PO Box 1236, Carrboro, NC 27510 <br />Applicant Organization’s Web Address: https://www.chapelhillcarrboronaacp.com <br />Executive Director (if applicable): Not applicable <br />Telephone Number: 206-954-4273 E-Mail: naacp5689@gmail.com <br />Tax ID Number: 45-3323968 <br />Funding Request Summary <br />Please list all Fiscal Year 2021 Community Climate Action Grant funding requested for all <br />projects you are proposing and the proposed use of funds (please list program name only). <br />Applicants will be asked to provide more details on their proposed program budget in the <br />Budget Worksheets attachment. <br />Project Equipment Operations Personnel Total <br />Water Heater Replacement $37,088.00 $67,912.00 $17,100.00 $122,100.00 <br />Totals $37,088.00 $67,912.00 $17,100.00 $122,100.00 <br /> <br />Briefly explain your proposed use of funds ( 2-4 sentences ): The purchase of 30 heat- <br />pump water heaters at $1,236 each yields $37088. 30 home assessments to determine <br />feasibility and installation details for $6000. Cost for balance of system and labor for <br />installation is $67,912. Administrative costs at 10% of project cost is $11,100. <br />To the best of my knowledge and belief all information and data in this <br />application is true and current. <br />Signature: <br /> Applicant’s Authorized Signatory Date <br />P a g e 6 o f 23 <br />DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134