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119 <br /> Include in the some PDF document as this form, after the Certifications section below, the <br /> following required documents. If an item is not applicable to your organization, please indicate <br /> this by an "N/A"and explain why it is not applicable. <br /> 3. Letters of Commitment and/or Support (Up to 5 letters) <br /> 4. Latest Audited Financial Statements, including Management letter(Attach letter <br /> of explanation if unable to provide) <br /> 5. Documentation of Tax Identification Number (can be IRS Determination Letter <br /> for non-profit agencies) <br /> 6. Certificate of Insurance <br /> 7. For non-profit agencies only: <br /> A. IRS Determination Letter: provide a copy of an IRS determination letter which <br /> states that your organization has been granted exemption from federal income tax <br /> under section 501(c)(3) of the Internal Revenue Code. The organization's name on <br /> the letter must match your current organization's name and address. This IRS <br /> determination letter can also satisfy the documentation requirement of your <br /> organization's tax identification number (TIN). <br /> B. Verification of 501(c)(3) Status Form: If applicable, an Authorized Representative <br /> must annually submit verification that the organization remains a qualified 501(c)(3) <br /> tax-exempt organization. <br /> C. Copy of Form 990 Federal Tax return filed for latest fiscal year. <br /> D. Agency organizational chart. <br /> E. Current Board of Directors Roster with names, addresses, office terms (with <br /> dates), and professional and/or community affiliations. N/A Department of Injury <br /> Prevention Research Center at University of North Carolina at Chapel Hill doesn't <br /> have their own board of directors. Please refer to departmental organization chart <br /> below. <br /> 8. For-profit agencies only: <br /> A. Current Board of Directors Roster with names, addresses, office terms (with <br /> dates), and professional and/or community affiliations. <br /> B. Appropriate tax form filed with IRS filed for latest fiscal year. <br /> C. Agency organizational chart. <br /> Insert/Attach these required documents here. <br /> 0 <br />