2022-366-E-Health-Farmer Foodshare-Outside Agency Agreement

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Cover Page Page 6 of 37 COVER PAGE Applicant Contact Information Applicant Organization’s Legal Name: Farmer Foodshare, Inc. Applicant Organization’s Physical Address: 902 N Mangum St, Durham, NC 27701 Applicant Organization’s Mailing Address: 902 N Mangum St, Durham, NC 27701 Applicant Organization’s Web Address: www.farmerfoodshare.org Executive Director: Dave Baylock (interim); Kelly O'Neill Crane (starts 1/17/2022) Telephone Number: 919.701.2543 E-Mail: info@farmerfoodshare.org Tax ID Number: Funding Request Please list all Fiscal Year 2023 Human Services (HS) funding requested for all programs and the proposed use of funds (please list program name only) Program Carrboro - HS Chapel Hill - HS Orange County-HS Total Fresh Food Purchasing (with Carolina Jews for Justice) $11,000 Operations $4,300 Personnel $0 $0 $15,300 Fresh Food Purchasing (with TABLE) $0 $11,000 Operations $4,300 Personnel $0 $15,300 Fresh Food Purchasing (with Local Food Connection & Eno River Farmers Market) $0 $0 $11,000 Operations $4,300 Personnel $15,300 Totals $15,300 $15,300 $15,300 $45,900 Briefly explain your proposed use of funds: To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Source, aggregate, and deliver fresh, NC-grown produce to families in need on a bi- weekly, weekly, or monthly basis, as determined by partner needs. Operations = fresh food costs. Personnel = staff time required for sourcing and delivering the fresh food. EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: BC021861-30DF-4F8A-9FA3-8AE2B71D28D0