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Docusign Envelope ID: El 96FFB6-481 D-48D1-A670-07B9001 1 COBE <br /> Community Climate Action Grant Program <br /> Application 2022-2023 <br /> SUBMISSION CHECKLIST <br /> Primary Applicant Organization: Town of Chapel Hill <br /> Project Name: Fleet Electrification Pilots <br /> Section Subsection <br /> Cover Page ® Applicant and Collaborator/Partner Contact Information <br /> ® Funding Request Summary <br /> ® Signed Application Cover Page <br /> Disclosure ® Signed Disclosure of Conflicts of Interest and Clause <br /> Applicant Organization and ® Applicant organization's Date of Incorporation(if applicable) <br /> Collaborator Information ® Applicant organization's Purpose/Mission(if applicable) <br /> ® Living Wage <br /> ® Schedule of Positions(if applicable) <br /> Project Information ® Project Name <br /> ® Project Description and Climate Plan Alignment <br /> ® Collaborator Information(if applicable) <br /> ® Criteria-Specific Sections 1-7 <br /> Attachments ® Applicant Organization's Annual Budget and Proposed Project Budget(Use <br /> template provided) <br /> (A description of these items is <br /> available on page 13:"Description ®Applicable Financial Records to prove eligibility: IRS Federal Form 990 or <br /> of Required Attachments."Please Applicant Organization's Tax Returns from 2021 <br /> contact us if it will not be <br /> possible to provide any of these ®Applicable Financial Records to prove eligibility of collaborator/partner(if <br /> required attachments at the time they are receiving project funds): IRS Federal Form 990 or Tax Returns from <br /> of application: 2021 <br /> aeckber2(a,oran2ecountync.2ov <br /> ® List of members of organization's Governing Board(if Board exists) <br /> ® Certificate of Insurance <br /> Page 1 of 21 <br />