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P a g e 1 o f 18 <br /> <br />Orange County Community Climate Action Grant - Application 2023-24 <br /> <br />SUBMISSION CHECKLIST <br /> <br />Primary Applicant Organization: Habitat for Humanity, Orange County, N.C., Inc. <br /> <br />Project Name: Supplemental Weatherization to Home Repair Projects <br /> <br />Section Subsection <br />Cover Page <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 /> Project Name <br /> Project Description and Climate Plan Alignment <br /> Collaborator Information (if applicable) <br /> Criteria-Specific Sections 1-7 <br /> <br />Attachments (A description of <br />these items is available on page <br />13: “Description of Required <br />Attachments.” Please contact us <br />if it will not be possible to <br />provide any of these required <br />attachments at the time of <br />application: <br />aeckberg@orangecountync.gov <br /> Applicant Organization’s Annual Budget and Proposed Project <br />Budget (Use template provided) <br /> Applicable Financial Records to prove eligibility: IRS Federal Form <br />990 or Applicant Organization’s Tax Returns from 2022 <br /> Applicable Financial Records to prove eligibility of <br />collaborator/partner (if they are receiving project funds): IRS Federal <br />Form 990 or Tax Returns from 2022 <br /> List of members of organization’s Governing Board (if Board exists) <br /> Certificate of Insurance <br /> <br />DocuSign Envelope ID: DBE8454E-5CDD-4377-A739-3C0016853D4E