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1/30/24, 5 00 PM HSOA 24 57 <br />https //chapelhillnc workflow opengov com/#/explore/records/63447/react form details/63447 12/13 <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 />Name of Person Submitting the Application <br />Courtnei McWilliams <br />Agency Role of Person Submitting the Application <br />Program Manager <br />Agency Representative Signature <br />Courtnei P McWilliams <br />Jan 12,2024 <br />If this grant is awarded,part of the funds will be allocated to staff salaries. <br />Docusign Envelope ID: 3F291284-28EA-4C38-99B9-60DFE2A69BE8