2022-129-E-AMS-Town Of Chapel Hill-Community Climate Action Grant - Tree Planting Program

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P a g e 3 o f 12 DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON- DISCRIMINATION CLAUSE Are any of the Board Members or employees of the organization which will be carrying out this project or their named project collaborators/partners or members of their immediate families, or their business associates… YES NO a) Employees of or closely related to employees of Orange County? b) Members of or closely related to members of the governing bodies of Orange County? c) Current beneficiaries of the program for which funds are being requested? d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question or know of any other potential conflict of interest regarding your application, please provide a full explanation here: There are Town employees who are closely related to employees of Orange County, though these staff members are not working on this project directly. Town Board Members and employees who live in Chapel Hill could benefit from this project through increased ecosystem services and community beautification. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: 11/9/20 Applicant’s Authorized Signatory Date John B Richardson Digitally signed by John B Richardson DN: cn=John B Richardson, o=Town of Chapel Hill, ou=Manager's Office, email=jrichardson@townofchapelhill.org, c=US Date: 2020.11.09 12:59:28 -05'00' DocuSign Envelope ID: 8858BEA8-FD65-4E72-A32A-868C9BDDE075