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Page 13 of 14 <br /> <br />Accommodations for applicants with disabilities or those in need of technical assistance are available <br />upon request. Please contact the Orange County Sustainability Programs Manager, Amy Eckberg (919- <br />245-2626, aeckberg@orangecountync.gov) to discuss what is needed. <br /> <br /> <br />ATTACHMENTS <br /> <br />Description of Required Attachments <br /> <br />a) Applicant Organization’s Budget and Project Budget <br />Please complete the provided budget worksheets for your organization and your proposed project or submit your <br />own budget file (as long as it contains the same information, and in a similar format, as requested in the provided <br />worksheets. Please explain other in your budget). The Budget Worksheets file is available for download from the <br />County website here . Please submit the budget in PDF form as well as in the original editable Excel format. <br /> <br />b) IRS Federal Form 990 or 2022 Tax Returns <br />A copy of the applicant organization’s most recent Form 990 or IRS Tax Returns is required to determine eligibility. <br />The specific form depends upon the applicant organization’s financial activity. Review the IRS’ guide, for more <br />details. For Form 990-N (e-postcard) filers, include a copy of the postcard, with the organization’s application <br />materials. <br /> <br />c) List of Board of Directors (if applicable) <br />Provide the following information about each board of director’s member: name, telephone number, and address, of <br />each member and the list must identify the principal officers of the governing body, and length of term. Please feel <br />free to use the template provided in Table 2 of the appendix or your own format. <br /> <br />d) Certificate of Liability Insurance <br />A copy of the applicant organization’s current certificate, from the organization’s insurance carrier. Table 1 below <br />outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker’s Compensation <br />compliance, include a statement explaining why, with the applicant organization’s application materials. <br /> <br />NOTE: Proof of insurance is not required at the time of application submission. If your agency is approved for <br />funding, documentation of insurance must be provided to the jurisdiction awarding the funding when the contract is <br />awarded. The insurance certificate should reflect the funding jurisdiction as an additional insured party and <br />certificate holder and provide coverage for the duration of the funding period (two years, beginning as early as <br />October 1, 2023). If proof of insurance can only be written for one year, an update will be required for all ongoing <br />projects. Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or <br />modification of any stipulated insurance coverage. <br /> <br />NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the County. Please <br />contact the staff identified on the Submission Requirements on Page 15 if you have questions or would like to <br />request a review of your insurance requirements. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />DocuSign Envelope ID: EB7B9CC8-B910-4965-AF93-0969E3E03E78