Orange County NC Website
Browse       Search
Cover Page P a g e 9 o f 28 <br /> <br />DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON- <br />DISCRIMINATION CLAUSE <br />Are any of the Board Members or employees of the agency which will be carrying out this <br />program or members of their immediate families, or their business associates. <br /> <br />YES NO <br /> <br /> a) Employees of or closely related to employees of the Town of Carrboro, the <br />Town of Chapel Hill, or Orange County? <br /> <br /> b) Members of or closely related to members of the governing bodies of the Town <br />of Carrboro, the Town of Chapel Hill, or Orange County? <br /> <br /> c) Current beneficiaries of the program for which funds are being requested? <br /> <br /> d) Paid providers of goods or services to the program or having other financial <br />interest in the program? <br />If you have answered YES to any question, please provide a full explanation below. <br /> <br />One of TABLE’s staff members is a beneficiary of our food access programming. This <br />parent learned about the job opening after they were already receiving services. By having <br />an individual who is both a staff member and a beneficiary, we believe this is a great asset <br />to our organization. It allows for an important perspective to be shared in staff <br />meetings/conversations and allows participating families to feel more comfortable <br />approaching a staff member. This employee is receiving a living wage like all other staff <br />members. <br /> <br />NON-DISCRIMINATION <br />Provider agrees as part of consideration of the granting of funds by funding agencies to <br />the parties hereto for themselves, their agents, officials, employees and servants agree <br />not to discriminate in any manner of these basis of race, color, gender, natio nal origin, <br />age, handicap, religion, sexual orientation, gender identity/expression, familial status or <br />veterans status with reference to any activities carried out by the grantee, no matter <br />how remote. The parties hereto further agree in all respects to conform to the provision <br />and intent of Orange County Civil Rights Ordinance, as amended and the Orange <br />County Anti-discrimination Policy. This provision is enforced by action for specific <br />performance, injunctive relief, or other remedy as by law provided; this provision shall <br />be binding on the grantees, the successors and assigns of the parties hereto with <br />reference to the above subject manner. <br />To the best of my knowledge and belief all of the above information is true and <br />current. I acknowledge and understand that the existence of a potential conflict of <br />interest does not necessarily make the program ineligible for funding, but the <br />existence of an undisclosed conflict may result in the termination of any grant <br />awarded. <br /> <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 5334673A-3749-4438-A4C5-1C05EECD11F3