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P a g e 1 o f 2 3 <br />Community Climate Action Grant Program <br />Application FY 2021-22 <br />SUBMISSION CHECKLIST <br />Primary Applicant Organization: The ArtsCenter <br />Project Name: A New Home for The ArtsCenter: Sustainability Upgrades <br />Section Subsection <br />Cover Page Applicant and Collaborator/Partner Contact Information <br />Funding Request Summary <br />Signed Application Cover Page <br />Disclosure Signed Disclosure of Conflicts of Interest and Clause <br />Applicant Organization and <br />Collaborator Information <br />Applicant organization’s Date of Incorporation (if applicable) <br />Applicant organization’s Purpose/Mission (if applicable) <br />Living Wage <br />Schedule of Positions (if applicable) <br />Project Information Project Name <br />Project Description and Climate Plan Alignment <br />Collaborator Information (if applicable) <br />Criteria-Specific Sections 1-7 <br />Attachments <br />(A description of these items is <br />available on page 13: “Description <br />of Required Attachments.” Please <br />contact us if it will not be <br />possible to provide any of these <br />required attachments at the time <br />of application: <br />bbouma@orangecountync.gov) <br />Applicant Organization’s Annual Budget and Proposed Project Budget (Use <br />template provided) <br /> <br />Applicable Financial Records to prove eligibility: IRS Federal Form 990 or <br />Applicant Organization’s Tax Returns from 2019 <br />Applicable Financial Records to prove eligibility of collaborator/partner (if <br />they are receiving project funds): IRS Federal Form 990 or Tax Returns from <br />2019 <br /> <br />List of members of organization’s Governing Board (if Board exists) <br />Solid Waste Program Fee (SWPF) Verification (for commercial property <br />owners and renters) <br />Certificate of Insurance <br />COVER PAGE <br />DocuSign Envelope ID: FC54AC26-7897-4270-8EA1-D754CD59EA76