Orange County NC Website
Browse       Search
DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND <br />NON-DISCRIMINATION CLAUSE <br />Are any of the Board Members or employees of the agency which will be carrying out this <br />program or 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 <br />Town of Chapel Hill, or Orange County? <br />☐☐b)Members of or closely related to members of the governing bodies of the Town <br />of Carrboro, 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 <br />interest in the program? <br />If you have answered YES to any question,please provide a full explanation below. <br />NON-DISCRIMINATION <br />Provider agrees as part of consideration of the granting of funds by funding agencies <br />to the parties hereto for themselves,their agents,officials,employees and servants <br />agree not to discriminate in any manner of these basis of race,color,gender,national <br />origin,age,handicap,religion,sexual orientation,gender identity/expression,familial <br />status or veterans status with reference to any activities carried out by the grantee,no <br />matter how remote. The parties hereto further agree in all respects to conform to the <br />provision and intent of Orange County Civil Rights Ordinance,as amended and the <br />Orange County Anti-discrimination Policy. This provision is enforced by action for <br />specific performance,injunctive relief,or other remedy as by law provided;this <br />provision shall be binding on the grantees,the successors and assigns of the parties <br />hereto with reference to the above subject manner. <br />To the best of my knowledge and belief all of the above information is true and <br />current.I acknowledge and understand that the existence of a potential conflict of <br />interest does not necessarily make the program ineligible for funding,but the <br />existence of an undisclosed conflict may result in the termination of any grant <br />awarded. <br />Signature:1/12/2023 <br />Executive Director Date <br />Cover Page Page 9 of 31 <br />DocuSign Envelope ID: 9F73F5ED-FE40-4DB1-BBAD-AF773010D285