Orange County NC Website
<br />3941 <br />Attachments <br /> <br />Description of Required Attachments <br /> <br />a) Applicant Organization’s Budget and Project Budget <br />Please complete the provided budget worksheets for your organization and your proposed <br />project or submit your own budget file (as long as it contains the same information, and in a <br />similar format, as requested in the provided worksheets. Please explain other in your budget). <br />The Budget Worksheets file is available for download from the County website here. Please <br />submit the budget in PDF form and in the original editable Excel format. <br /> <br />b) IRS Federal Form 990 or 2023 Tax Returns <br />A copy of the applicant organization’s most recent Form 990 or IRS Tax Returns is required to <br />determine eligibility. The specific form depends upon the applicant organization’s financial <br />activity. Review the IRS’ guide, for more details. For Form 990-N (e-postcard) filers, include a <br />copy of the postcard, with the organization’s application materials. <br /> <br />c) IRS Federal Form 990 or 2023 Tax Returns for collaborator/partner (if they are <br />receiving project funds) <br />A copy of the collaborator/partner’s most recent Form 990 or IRS Tax Returns is required to <br />determine eligibility. The specific form depends upon the organization’s financial activity. Review <br />the IRS’ guide, for more details. For Form 990-N (e-postcard) filers, include a copy of the <br />postcard, with the organization’s application materials. <br /> <br />d) List of Board of Directors (if applicable) <br />Provide the following information about each member of the board of directors: name, telephone <br />number, and address. The list must identify the principal officers of the governing body and the <br />length of term. Please feel free to use the template provided in Table 2 of the appendix or your <br />own format. <br /> <br />e) Certificate of Liability Insurance <br />A copy of the applicant organization’s current certificate, from the organization’s insurance <br />carrier. Table 1 below outlines insurance types and minimums required, for each jurisdiction. If <br />exempt from Worker’s Compensation compliance, include a statement explaining why, with the <br />applicant organization’s application materials. <br /> <br />NOTE: Proof of insurance is not required at the time of application submission. If your agency <br />is approved for funding, documentation of insurance must be provided to the jurisdiction <br />awarding the funding when the contract is awarded. The insurance certificate should reflect the <br />funding jurisdiction as an additional insured party and certificate holder and provide coverage <br />for the duration of the funding period (two years, beginning as early as October 1, 2024). If proof <br />of insurance can only be written for one year, an update will be required for all ongoing projects. <br />Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, <br />cancellation or modification of any stipulated insurance coverage. <br /> <br />NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the <br />County. Please contact the staff identified on the Submission Requirements on Page 12 if you <br />have questions or would like to request a review of your insurance requirements. <br />Docusign Envelope ID: 7E7D300B-F83F-4917-A8A3-638B79C7D566