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DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON- <br />DISCRIMINATION CLAUSE <br />Are any of the Board Members or employees of the organization which will be carrying out <br />this project or their named project collaborators/partners or members of their immediate <br />families, or their business associates… <br />YES NO <br /> X a) Employees of or closely related to employees of Orange County? <br /> X b) Members of or closely related to members of the governing bodies of Orange <br />County? <br /> X c) Current beneficiaries of the program for which funds are being requested? <br /> X d) Paid providers of goods or services to the program or having other financial <br />interest in the program? <br />If you have answered YES to any question or know of any other potential conflict of interest <br />regarding your application, please provide a full explanation here: <br /> <br />NON-DISCRIMINATION <br />Provider agrees as part of consideration of the granting of funds by funding agencies <br />to the parties hereto for themselves, their agents, officials, employees and servants <br />agree not to discriminate in any manner of these basis of race, color, gender, national <br />origin, age, handicap, religion, sexual orientation, gender identity/expression, familial <br />status or veterans status with reference to any activities carried out by the grantee, no <br />matter how remote. The parties hereto further agree in all respects to conform to the <br />provision and intent of Orange County Civil Rights Ordinance, as amended and the <br />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 <br />provision shall be binding on the grantees, the successors and assigns of the parties <br />hereto with reference to the above subject manner. <br />To the best of my knowledge and belief all of the above information is true and <br />current. I acknowledge and understand that the existence of a potential conflict of <br />interest does not necessarily make the program ineligible for funding, but the <br />existence of an undisclosed conflict may result in the termination of any grant <br />awarded. <br />Signature: <br /> Applicant’s Authorized Signatory Date <br />P a g e 7 o f 23 <br />DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134