Orange County NC Website
Browse       Search
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 <br />members of their immediate families, or their business associates. <br />YES NO <br />☐ ☑a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel <br />Hill, or Orange County? <br />☐ ☑b) Members of or closely related to members of the governing bodies of the Town of Carrboro, <br />the Town of Chapel Hill, or Orange County? <br />☐ ☑c) Current beneficiaries of the program for which funds are being requested? <br />☐ ☑d) Paid providers of goods or services to the program or having other financial interest in the <br />program? <br />If you have answered YES to any question,please provide a full explanation below. <br />PORCH-Hillsborough board member, Mark Bell, is a commissioner for the Town of <br />Hillsborough. <br />NON-DISCRIMINATION <br />Provider agrees as part of consideration of the granting of funds by funding agencies to the parties <br />hereto for themselves, their agents, officials, employees and servants agree not to discriminate in <br />any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual <br />orientation, gender identity/expression, familial status or veterans status with reference to any <br />activities carried out by the grantee, no matter how remote. The parties hereto further agree in all <br />respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as <br />amended and the Orange County Anti-discrimination Policy. This provision is enforced by action <br />for specific performance, injunctive relief, or other remedy as by law provided; this provision shall <br />be binding on the grantees, the successors and assigns of the parties hereto with reference to the <br />above subject manner. <br />To the best of my knowledge and belief all of the above information is true and current. I acknowledge <br />and understand that the existence of a potential conflict of interest does not necessarily make the <br />program ineligible for funding, but the existence of an undisclosed conflict may result in the <br />termination of any grant awarded. <br />Signature: <br />Executive Director Date <br />Signature: <br /> <br /> <br />DocuSign Envelope ID: 1D36C59C-C145-4DEC-B613-31B2A8CEC6ED