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A3. Is your mailing <br />address different <br />than your physical <br />address? <br />No <br />A4. W eb Address (if <br />applicable) <br />www.tablenc.org <br />A5. Preferred Phone <br />Number <br />+19196364860 <br />A6. E-Mail ldille@tablenc.org <br />A7. Tax ID Number 26-1471735 <br />A8. W here did you <br />hear about this grant <br />opportunity? <br />Other <br />A8a. Please describe <br />how you heard about <br />this grant <br />opportunity. <br />W ord of mouth <br />A9. Have you applied <br />to this grant <br />opportunity before? <br />No <br />Disclosure of <br />Potential Conflicts of <br />Interest and Non- <br />Discrimination <br />Clause <br />Are any of the Board Members or employees of the organization which will <br />be carrying out this project or their named project collaborators/partners or <br />members of their immediate families, or their business associates: <br />A10. Select any of <br />the following that <br />apply: <br />e. Not applicable / NA <br />A11. NON- <br />DISCRIMINATION <br />Provider agrees as part of consideration of the granting of funds by funding <br />agencies to the parties hereto for themselves, their agents, officials, <br />employees and servants agree not to discriminate in any manner on the <br />basis of race, color, gender, national origin, age, handicap, religion, sexual <br />orientation, gender identity/expression, familial status or veterans status <br />with reference to any activities carried out by the grantee, no matter how <br />remote. The parties hereto further agree in all respects to conform to the <br />provision and intent of Orange County Civil Rights Ordinance, as amended <br />and the Orange County Anti-discrimination Policy. This provision is <br />enforced by action for specific performance, injunctive rel ef, or other <br />remedy as by law provided; this provision shall be binding on the grantees, <br />the successors and assigns of the parties hereto with reference to the <br />above subject manner. <br />Docusign Envelope ID: 607995AB-FD72-4B81-91C2-2C0A73A91963