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<br />Page 2 of 41 <br />Attachments <br />(A description of these items <br />is available on page 13: <br />“Description of Required <br />Attachments.” Please contact <br />us if it will not be possible to <br />provide any of these required <br />attachments at the time of <br />application: <br />sustainability@orangecounty <br />nc.gov <br />☐ Applicant Organization’s Annual Budget and Proposed Project Budget (Use <br />template provided) <br />☐ Applicable Financial Records to prove eligibility: IRS Federal Form 990 or <br />Applicant Organization’s Tax Returns from 2023 <br />☐ Applicable Financial Records to prove eligibility of collaborator/partner (if <br />they are receiving project funds): IRS Federal Form 990 or Tax Returns from <br />2023 <br />☐ List of members of organization’s Governing Board (if Board exists) <br />☐ Certificate of Insurance <br /> <br /> <br /> <br /> <br /> <br />COVER PAGE <br /> <br />Applicant Organization’s Contact Information <br />Organization’s Legal Name: Urban Sustainability Solutions <br />Physical Address: <br />Mailing Address: <br />1433 Major Hill Road <br />Snow Camp, NC 27349 <br />Web Address: www.urbanss.org <br />Telephone Number: (336)-266-4841 <br />E-Mail: michaelgdupree@gmail.com; <br />grants.urbanss.org@gmail.com <br />Tax ID Number: 88-3142713 <br /> <br /> <br /> <br /> <br />Funding Request Summary <br /> <br />Please list all proposed projects (please list project name only) for which you are requesting Community Climate Action <br />Grant funding for Fiscal Year 2024-25. Make sure to include a brief description of the proposed use of funds. Applicants <br />will be asked to provide more details on their proposed project budget in the Budget Worksheets attachment. <br />Docusign Envelope ID: 7E7D300B-F83F-4917-A8A3-638B79C7D566