2024-230-E-Planning Dept-Town of Carrboro-Planning Zoning and Inspections

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P a g e 20 o f 22 A copy of the applicant organization’s most recent Form 990 or IRS Tax Returns is required to determine eligibility. The specific form depends upon the applicant organization’s financial activity. Review the IRS’ guide, for more details. For Form 990-N (e-postcard) filers, include a copy of the postcard, with the organization’s application materials. c) List of Board of Directors (if applicable) Provide the following information about each board of director’s member: name, telephone number, and address, of each member and the list must identify the principal officers of the governing b ody, and length of term. Please feel free to use the template provided in Table 2 of the appendix or your own format. d) Solid Waste Program Fee (SWPF) Verification This fee finances Orange County's recycling and waste reduction program. Submit either a.) proof of payment of the applicant organization’s FY 2019-20 Solid Waste Program Fee, OR b.) a statement on the applicant organization’s letterhead indicating exemption and specify the person(s), business, etc. that is responsible for paying this fee. e) Certificate of Liability Insurance A copy of the applicant organization’s current certificate, from the organization’s insurance carrier. Table 1 below outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker’s Compensation compliance, include a statement explaining why, with the applicant organization’s application materials. NOTE: Proof of insurance is not required at the time of application submission . If your agency is approved for funding, documentation of insurance must be provided to the jurisdiction awarding the funding when the contract is awarded. The insurance certificate should reflect the funding jurisdiction as an additional insured party and certificate holder and provide coverage for the duration of the funding period (two years, beginning as early as October 1, 2021). If proof of insurance can only be written for one year, an update will be required for all ongoing projects. Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or modification of any stipulated insurance coverage. NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the County. Please contact the staff identified on the Submission Requirements on Page 15 if you have questions or would like to request a review of your insurance requirements. APPENDIX Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required INSURANCE ORANGE COUNTY3 Worker's Compensation1 Limits for Coverage A - Statutory State NC, for each employee Limits for Coverage B - Employers Liability of: $500,000 each accident, $500,000 Bodily Injury by Disease (BID).for each employee $500,000 for BID limit Commercial General Liability $1 million Each Occurrence $2 million Aggregate Automobile Liability $1 million Each Occurrence Professional Liability $1 million Each Occurrence $2 million Aggregate DocuSign Envelope ID: 08DD74BE-CE96-4D90-9C72-8BD18C25E2E7