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Communitv Climate Action Grant Program <br />Application 2022-2023 <br />SUBMISSION CHECKLIST <br />Primary Applicant Organization: Rebuildins Tosether of the Triansle" Inc. <br />Project Name: Supplemental Weatherization for Low-Income Orange County Homeowners <br />xx <br />X <br />Applicant and Collaborator/Partner Contact Information <br />Funding Request Summary <br />Signed Application Cover Page <br />[l 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 />xxxx <br />Project Information Project Name <br />Project Description and Climate Plan Alignment <br />Collaborator Information (if applicable) <br />Criteria-Specifi c Sections 1-7 <br />xxxx <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 />possitrle to provide any of these <br />required attachments at the time <br />of application: <br />aeckberg@orangecountync.qov <br />I Applicant Organization's Annual Budget and Proposed Project Budget (t/se <br />template provided) <br />I Appticable Financial Records to prove eligibility: IRS Federal Form 990 or <br />Applicant Organization's Tax Returns from 2021 <br />[l 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 />2021 <br />[l Ust of members of organization's Governing Board (if Board exists) <br />X Certificate of Insurance <br />Page ,r, of 1,9 <br />Section Subsection <br />Cover Page <br />Disclosure <br />DocuSign Envelope ID: 3B3ED7CA-61F5-4E47-87CD-95256B532A12