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Agenda 05-06-25; 6-a - Opioid Advisory Committee Settlement Fund Use Recommendations
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Agenda 05-06-25; 6-a - Opioid Advisory Committee Settlement Fund Use Recommendations
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5/1/2025 1:21:21 PM
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BOCC
Date
5/6/2025
Meeting Type
Business
Document Type
Agenda
Agenda Item
6-a
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24 <br /> Include in the same PDF document as this form, after the Certifications section below, the following <br /> required documents. If an item is not applicable to your organization, please indicate this by an "N/A" <br /> 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 of explanation if <br /> unable to provide) <br /> 5. Documentation of Tax Identification Number(can be IRS Determination Letter 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 states that your <br /> organization has been granted exemption from federal income tax under section 501(c)(3) of the <br /> Internal Revenue Code.The organization's name on the letter must match your current <br /> organization's name and address.This IRS determination letter can also satisfy the documentation <br /> requirement of your organization's tax identification number(TIN). <br /> B. Verification of 501(c)(3) Status Form: If applicable, an Authorized Representative must annually <br /> submit verification that the organization remains a qualified 501(c)(3)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 dates), and <br /> professional and/or community affiliations. <br /> 8. For-profit agencies only: <br /> A. Current Board of Directors Roster with names, addresses, office terms (with dates), and <br /> 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 /> 1 <br />
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