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1/12/24, 10:17 AM HSOA-24-16 <br />https://chapelhillnc.workflow.opengov.com/#/explore/records/63230/296812 12/13 <br />Are any board members or agency employees, <br />including their immediate relatives and business <br />associates, paid providers of goods or services to or <br />have other financial interest in the proposed <br />program? <br />No <br />Are any board members or employees, including <br />their immediate relatives and business associates, <br />related to employees of that Town of Chapel Hill, <br />Town of Carrboro, or Orange County? <br />Yes <br />If the answer to any of the above is yes, please provide an explanation. <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 />Matt Hughes is currently a Hillsborough Town Commissioner and serves as the Chair <br />of the HHC. Peter Sandbeck works as the Cultural Resources Coordinator for Orange <br />County. Our 6 ex-officio members serve as employees of Orange County and are on <br />the board by virtue of their position. <br />Docusign Envelope ID: F5E5F5C2-1D2F-4220-AB83-15724033E4F0