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ConflictofInterest <br />Asanapplicantrequestingfunding,willanyofyouremployees,agents,consultants,officers,orelectedofficials <br />experiencethefollowingconflictsofinterest: <br />Participateinthedecisionmakingprocessfortheapprovalofthisapplication?(i.e.,anAnokaCountyCommissioneror <br />HRATrustee)NoYes <br />Haveafinancialinterestorreapafinancialbenefitfromthisprogram/activity?NoYes <br />Haveaninterestinanycontract,subcontract,oragreementwithrespecttothisapplicationeitherforthemselvesor <br />thosewithwhomtheyhavefamilyorbusinesstiesduringtheprogramyearandforoneyearthereafter? <br />NoYes <br />*Ifyouselected,ͻǤĻƭͲͼtoanyoftheabove,clearlydescribetheconflictbelow. <br />Clickortapheretoentertext. <br />REQUIREDDOCUMENTATION <br />Thesedocumentsarerequiredtobeattachedtothefinalapplicationsubmission: <br /> StateandFederalTaxExemptionDeterminationLetter <br /> ListofBoardofDirectors/CouncilorTrustees <br />Ifyouractivityisfunded,thesedocumentsarerequiredpriortoSubRecipientAgreementcompletion: <br /> CopyoftheğƦƦƌźĭğƓƷ͸ƭpreviousǤĻğƩ͸ƭAudit,Management&ComplianceReport <br /> Copyof/ƚƓƷƩğĭƷƚƩ͸ƭInsuranceCoverageasrequiredintheapplicablecontractΑInsurance.(TheInsurance <br />ExhibitwillbeprovidedafterfundingisallocatedandacontractorisselectedbyAgency.) <br />ApplicantAgencyInformation <br />501(c)(3)Dƚǝ͸ƷΉtǒĬƌźĭForProfitFaithBasedOther: <br />Typeofagency: <br />DUNSnumberFederalTaxIDnumber: <br />Annualoperatingbudget: <br />5 <br /> <br />