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Page 1 of 21 <br /> <br /> <br />Community Climate Action Grant Program <br />Application 2022-2023 <br /> <br />SUBMISSION CHECKLIST <br /> <br />Primary Applicant Organization: ____Town of Chapel Hill__________________________ <br /> <br />Project Name: _Fleet Electrification Pilots__________________________________________ <br /> <br /> <br />Section Subsection <br />Cover Page <br /> <br /> Applicant and Collaborator/Partner Contact Information <br /> Funding Request Summary <br /> Signed Application Cover Page <br />Disclosure 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 /> <br />Project Information <br /> <br /> Project Name <br /> Project Description and Climate Plan Alignment <br /> Collaborator Information (if applicable) <br /> Criteria-Specific Sections 1-7 <br /> <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 />possible to provide any of these <br />required attachments at the time <br />of application: <br />aeckberg@orangecountync.gov <br /> <br /> <br /> <br /> Applicant Organization’s Annual Budget and Proposed Project Budget (Use <br />template provided) <br /> Applicable Financial Records to prove eligibility: IRS Federal Form 990 or <br />Applicant Organization’s Tax Returns from 2021 <br /> 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 /> List of members of organization’s Governing Board (if Board exists) <br /> Certificate of Insurance <br /> <br /> <br /> <br />DocuSign Envelope ID: 494A0BDA-FFC8-478D-826D-7FA71E3E3A5C