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<br />Program information Page 8 of 33 <br />DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON-DISCRIMINATION CLAUSE <br />Are any of the Board Members or employees of the agency which will be carrying out this program or members <br />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 Town of Chapel Hill, <br />or Orange County? <br /> <br /> b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the <br />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 interest in the program? <br /> <br />If you have answered YES to any question, please provide a full explanation below. <br />• Embracing a commitment to equity and representation of all stakeholder <br />perspectives, IFC prioritizes including current recipients of services and others with <br />lived experience on our Board of Directors. One member of our Board accesses IFC <br />services. <br />• Some of our part-time shelter staff members are employed by Orange County. <br /> <br />NON-DISCRIMINATION <br />Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto <br />for themselves, their agents, officials, employees and servants agree not to discriminate in any manner <br />of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender <br />identity/expression, familial status or veterans status with reference to any activities carried out by the <br />grantee, no matter how remote. The parties hereto further agree in all respects to conform to the <br />provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti- <br />discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or <br />other remedy as by law provided; this provision shall be binding on the grantees, the successors and <br />assigns of the parties hereto with reference to the above subject manner. <br />To the best of my knowledge and belief all of the above information is true and current. I <br />acknowledge and understand that the existence of a potential conflict of interest does not necessarily <br />make the program ineligible for funding, but the existence of an undisclosed conflict may result in the <br />termination of any grant awarded. <br /> <br /> <br />Signature: 1/13/2022 <br /> President and CEO Date <br /> <br />Signature: 1/13/2022 <br /> Board Chairperson Date <br />DocuSign Envelope ID: D55BA9F3-2E5A-43E1-B098-5435F6FD4E2D