Agenda 05-06-25; 6-a - Opioid Advisory Committee Settlement Fund Use Recommendations

Browse Search

25 9. Certifications and Required Forms A. Application Certification I have reviewed this application for accuracy. I understand that Opioid Abatement funds are intended to address specific remediation activities as identified under the NC Memorandum of Agreement(MOA) for the Opioid Settlement Funds. I understand that these opioid settlement funds are subject to State laws and regulations, and I have read the MOA and agree to the requirements. I certify that the requested funds will be used in compliance with these requirements and with all requirements outlined in the Orange County High Impact Opioid Abatement Strategies RFA. I agree to submit invoices and other relevant documentation to Orange County to pay or be reimbursed, as well as quarterly status reports, by the date stated in the contract. I understand that Orange County requires agencies with receipts less than $500,000 that do not have a financial audit (or a financial report), prepared by a certified public accountant(CPA)to complete schedule of Receipts and Expenditures form. An agency does not need to complete this form if it has a prepared audit/report it can submit for the calendar year ending December 31, 2022 or the fiscal year ending June 30, 2023. Agencies with receipts totaling$500,000 or more,from any source, must submit a CPA-certified financial audit. financial statements for each year that opioid settlement funding is provided to my organization, and that Orange County may monitor the program during the award period. Agency Authorized Official (print name) Click or tap here to enter text. Signature Title Click or tap here to enter text. Date Click or tap here to enter text. Board Chair/Elected Official (print name) Click or tap here to enter text. Signature Title Click or tap here to enter text. Date Click or tap here to enter text. 1