2023-134-E-AMS-Rebuilding Together of the Triangle-Weatherization

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Please note that late, handwritten, or incomplete applications will not be accepted. Submit all documents including attachments in PDF format, This will ensure the original content and formatting is preserved. Digital signatures on applications are accepted. Accommodations for applicants with disabilities or those in need of technical assistance are available upon request. Please contact the Orange County Sustainability Programs Manager, Amy Eckberg (919- 245-2626, aeckbe rg@ora ngecountync.gov) to discuss what is needed. ATTACHMENTS Description of Required Attachments a) Applicant Organization's Budget and Project Budget Please complete the provided budget worksheets for your organization and your proposed project or submit your own budget file (as long as it contains the sarne information, and in a similar format, as requested in the provided worksheets. Please explain other in your budget). The Budget Worksheets file is available for download from the County website hcle. Please submit the budget in PDF form as well as in the original editable Excel format. b) IRS Federal Form 990 or2020 Tax Returns A copy of the applicant organization's most recent Form 990 or IRS Tax Returns is required to determine eligibility. The specific form depends upon the applicant organization's financial activity. Review the IRS' guide. for more details. For Form 990-N (e-postcard) filers, include a copy of the postcard, with the organization's application materials. c) List of Board of Directors (if applicable) Provide the following infonnation about each board of director's rnernber: name, telephone nurnber, and address, of each member and the list rnust identifz the principal officers of the governing body, and length of term. please feel fi'ee to use the template provided in Table 2 of the appendix or your own format. d) Certificate of Liability Insurance A copy of the applicant organization's current certificate, fi'om the organization's insurance carrier. Table I below outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker's Compensation compliance, include a statement explaining why, with the applicant organization's application materials. NOTE: Proof of insurance is not required at the time of application submission. If your agency is approved for funding, documentation of insurance must be provided to the jurisdiction awarding the funding when the contract is awarded. The insurance certificate should reflect the funding jurisdiction as an additional insured party and certificatc holder and provide coverage for the duration ofthe funding period (two years, beginning as early as October | ,2022).If proof of insurance can only be written for one year, an update will be required for all ongoing projects. Renewal ceftificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or rnodification of any stipulated insurance coverage. NOTE: Upon request, insurance requirements rnay be reviewed on a case by case basis by the County. Please contact the staff identified on the Submission Requirernents on Page l5 ifyou have questions or would like to request a review of your insurance requirements. APPENDIX Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required g(of L9 DocuSign Envelope ID: 3B3ED7CA-61F5-4E47-87CD-95256B532A12