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1/30/24, 9:39 AM HSOA-24-6 <br />https://chapelhillnc.workflow.opengov.com/#/explore/records/62569/react-form-details/62569 14/15 <br />Non-discrimination Clause <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, <br />no matter how remote. The parties hereto further agree in all respects to conform to <br />the provision and intent of Orange County Civil Rights Ordinance, as amended, and <br />the 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 />Applicant Statement <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 />Name of Person Submitting the Application <br />Madison Hayes <br />Agency Role of Person Submitting the Application <br />Co-Executive Director <br />Agency Representative Signature <br />Madison Hayes <br />Jan 8, 2024 <br />By submitting this application, the agency representative noted above affirms <br />they are either the Executive Director, or, if someone other than the Executive <br />Director is submitting this application, they affirm the Executive Director has <br />reviewed the application for accuracy and approved it for submittal. <br />Approval Details <br />Docusign Envelope ID: 9A1CFCD5-41FF-4C02-9172-BC499052FC3A