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P a g e 17 o f 19 <br />ATTACHMENTS <br />Description of Required Attachments <br />a)Applicant Organization’s Budget and Project Budget <br />Please complete the provided budget worksheets for your organization and your proposed project or submit your <br />own budget file (as long as it contains the same information, and in a similar format, as requested in the provided <br />worksheets. Please explain other in your budget). The Budget Worksheets file is available for download from the <br />County website here. Please submit the budget in PDF form as well as in the original editable Excel format. <br />b)IRS Federal Form 990 or 2019 Tax Returns <br />A copy of the applicant organization’s most recent Form 990 or IRS Tax Returns is required to determine eligibility. <br />The specific form depends upon the applicant organization’s financial activity. Review the IRS’ guide, for more <br />details. For Form 990-N (e-postcard) filers, include a copy of the postcard, with the organization’s application <br />materials. <br />c)List of Board of Directors (if applicable) <br />Provide the following information about each board of director’s member: name, telephone number, and address, of <br />each member and the list must identify the principal officers of the governing body, and length of term. Please feel <br />free to use the template provided in Table 2 of the appendix or your own format. <br />d)Solid Waste Program Fee (SWPF) Verification <br />This fee finances Orange County's recycling and waste reduction program. Submit either a.) proof of payment of the <br />applicant organization’s FY 2019-20 Solid Waste Program Fee, OR b.) a statement on the applicant organization’s <br />letterhead indicating exemption and specify the person(s), business, etc. that is responsible for paying this fee. <br />e)Certificate of Liability Insurance <br />A copy of the applicant organization’s current certificate, from the organization’s insurance carrier. Table 1 below <br />outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker’s Compensation <br />compliance, include a statement explaining why, with the applicant organization’s application materials. <br />NOTE: Proof of insurance is not required at the time o f application submission. If your agency is approved for <br />funding, documentation of insurance must be provided to the jurisdiction awarding the funding when the contract is <br />awarded. The insurance certificate should reflect the funding jurisdiction as an additional insured party and certificate <br />holder and provide coverage for the duration of the funding period (two years, beginning as early as October 1, 2021). <br />If proof of insurance can only be written for one year, an update will be required for all ongoin g projects. Renewal <br />certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or modification of any <br />stipulated insurance coverage. <br />NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the County. Please contact <br />the staff identified on the Submission Requirements on Page 15 if you have questions or would like to request a review <br />of your insurance requirements. <br />APPENDIX <br />Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required <br />INSURANCE ORANGE COUNTY3 <br />DocuSign Envelope ID: 925D6FBC-24A8-425B-8158-E760CA6EAD2A