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Community Climate Action Grant Program <br />Application FY 2022-23 <br />SUBMISSION CHECKLIST <br />Primary Applicant Organization: Habitat for Humanity, Orange County, N.C., Inc. <br />Project Name: Rooftop Solar Panels for Affordable Habitat Homes <br />Section Subsection <br />Cover Page X Applicant and Collaborator/Partner Contact Information <br />X Funding Request Summary <br />X Signed Application Cover Page <br />Disclosure X Signed Disclosure of Conflicts of Interest and Clause <br />Applicant Organization <br />and Collaborator <br />Information <br />X Applicant organization’s Date of Incorporation (if applicable) <br />X Applicant organization’s Purpose/Mission (if applicable) <br />X Living Wage <br />X Schedule of Positions (if applicable) <br />Project Information X Project Name <br />X Project Description and Climate Plan Alignment <br />X Collaborator Information (if applicable) <br />X Criteria-Specific Sections 1-7 <br />Attachments <br />(A description of these items is <br />available on page 13: <br />“Description of Required <br />Attachments.” Please contact <br />us if it will not be <br />possible to provide any of <br />these required attachments at <br />the time of application: <br />aeckberg@orangecountync.gov <br />X Applicant Organization’s Annual Budget and Proposed Project Budget (Use <br />template provided) <br />X Applicable Financial Records to prove eligibility: IRS Federal Form 990 <br />or Applicant Organization’s Tax Returns from 2021 <br /> <br />N/A Applicable Financial Records to prove eligibility of collaborator/partner <br />(if they are receiving project funds): IRS Federal Form 990 or Tax Returns <br />from 2021 <br />X List of members of organization’s Governing Board (if Board <br />exists) <br />X. Certificate of Insurance <br /> <br /> <br />P a g e 1 o f 1 5 <br />DocuSign Envelope ID: 9E4C108B-9C5C-4E75-9AF1-C4CA2E16CEC5