Orange County NC Website
<br />Page 21 of 22 <br /> <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 project or submit your own <br />budget file (as long as it contains the same information, and in a similar format, as requested in the provided worksheets. <br />Please explain other in your budget). The Budget Worksheets file is available for download from the County website here. <br />Please 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 determine eligibility. The specific <br />form depends upon the applicant organization’s financial activity. Review the IRS’ guide, for more details. For Form 990-N (e- <br />postcard) filers, include a 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 receiving project funds) <br />A copy of the collaborator/partner’s most recent Form 990 or IRS Tax Returns is required to determine eligibility. The specific <br />form depends upon the organization’s financial activity. Review the IRS’ guide, for more details. For Form 990-N (e-postcard) <br />filers, include a copy of the 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 number, and address. The <br />list must identify the principal officers of the governing body and the length of term. Please feel free to use the template <br />provided in Table 2 of the appendix or your own format. <br /> <br />e) Certificate of Liability Insurance <br />A copy of the applicant organization’s current certificate, from the organization’s insurance carrier. Table 1 below outlines <br />insurance types and minimums required, for each jurisdiction. If exempt from Worker’s Compensation compliance, include a <br />statement explaining why, with the applicant organization’s application materials. <br /> <br />NOTE: Proof of insurance is not required at the time of application submission. If your agency is approved for funding, <br />documentation of insurance must be provided to the jurisdiction awarding the funding when the contract is awarded. The <br />insurance certificate should reflect the funding jurisdiction as an additional insured party and certificate holder and provide <br />coverage for the duration of the funding period (two years, beginning as early as October 1, 2024). If proof of insurance can <br />only be written for one year, an update will be required for all ongoing projects. Renewal certificates must be sent to the <br />jurisdiction 30 days prior to any expiration date, 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 County. Please contact the <br />staff identified on the Submission Requirements on Page 12 if you have questions or would like to request a review of your <br />insurance requirements. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Docusign Envelope ID: AA482F5E-25D4-439A-862A-65CC63DF3A74