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DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND <br /> NON-DISCRIMINATION CLAUSE <br /> Are any of the Board Members or employees of the organization which will be carrying out this project or their named <br /> project collaborators/partners or members of their immediate families, or their business associates: <br /> YES NO <br /> a) Employees of or closely related to employees of Orange County? <br /> b) Members of or closely related to members of the governing bodies of Orange County? <br /> c) Current beneficiaries of the program for which funds are being requested? <br /> d) Paid providers of goods or services to the program or have other financial interests in the program? <br /> If you have answered YES to any question or know of any other potential conflict of interest regarding your application, <br /> please provide a full explanation here: <br /> We don’t need to submit a certificate of insurance <br /> NON-DISCRIMINATION <br /> Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for <br /> themselves, their agents, officials, employees and servants agree not to discriminate in any manner on the basis of <br /> race, color, gender, national 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, no matter how remote. The <br /> parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights <br /> Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action <br /> for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on <br /> the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. <br /> To the best of my knowledge and belief all of the above information is true and current. I <br /> acknowledge and understand that the existence of a potential conflict of interest does not <br /> necessarily make the program ineligible for funding, but the existence of an undisclosed <br /> conflict may result in the termination of any grant awarded . <br /> Signature: Kaya Johnson August 16, 2024 <br /> Applicant’s Authorized Signatory Date <br /> Page 4 of 28 <br />Docusign Envelope ID: 257985C7-FC41-4937-8E64-B610C38DBA58