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Habitat for Humanity, Orange County, N.C., Inc. <br />Orange County Community Climate Action Grant Program Performance <br />Agreement Rev. 2/21 Page 11 of 11 <br /> <br />ATTACHMENT “A” <br /> <br />Orange County Certifications – FY 2020-21 <br />Community Climate Action Grant Program <br />Performance Agreement <br /> <br /> <br />Primary Contact, Chief Executive Officer / Executive Director, and Chief Financial Officer <br />I certify that I have provided the primary contact and chief executive officer or executive director, and <br />chief financial officer for my agency with this Agreement and that I will keep it current to the County of <br />Orange. The list should be in writing with the name, title, phone and email address and if possible, fax <br />number. <br /> <br /> <br />Board of Directors and Officers of the Board <br />I certify that I have provided a current list of the Board of Directors and Officers of the Board with this <br />Agreement and that we will continue to update the list as changes occur. The list should be in writing, <br />with the name, physical address, mailing address and if possible, phone, fax and email address. <br /> <br /> <br />Project Budget Submission <br />I certify that I have provided a project budget for the period to be covered by Orange County funding, and <br />that any substantive changes made to this budget have been in advance authorized in writing by Orange <br />County. <br /> <br /> <br />Agency Budget Submission <br />I certify that I have provided the requested information from the latest budget adopted by the agency for <br />the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. <br /> <br /> <br />Alignment with Organization’s Mission <br />I certify that the programs and services for which this funding is requested align with the mission of the <br />organization. <br /> <br /> <br />Intended Purpose <br />I certify that the funds provided to the agency under the terms of this Agreement will be used for a public <br />purpose and shall only be used for the purposes intended and any money not used for those purposes will be <br />promptly returned to Orange County. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Certified by: <br />(Provider’s Signature) <br />Title: President & CEO Date: <br />DocuSign Envelope ID: 0E2E518B-BEF7-4AF0-8D07-FCD05F094BD6 <br />10/21/2021