HomeMy WebLinkAboutFY16 Museum Grassroots Science grant award contract. Ali
Grant IDGA64MOUTIOM
This Contract is hereby entered into by and between the North Carolina Department of Commerce (the "Agency') and the
Cape Fear Museum, Inc. c/o New Hanover County (the "Grantee ") (referred to collectively as the "Parties "). The Grantee's
federal tax identification number is 566000324.
1. Contract Documents:
This Contract consists of the following documents:
(1) This Contract
(2) Notice of Certain Reporting and Audit Requirements (Attachment A)
(3) Certification of No Overdue Tax Debts (Attachment B)
(4) The General Terms and Conditions (Attachment C)
(5) Annual Budget (Attachment D)
(6) Session Law 2015 -241, House Bill 97, Section 6.26 and 15.18 (Attachment E)
These documents constitute the entire agreement between the Parties and supersede all oral and written statements,
negotiations or agreements made, communicated, negotiated or entered into prior to or contemporaneously with the full
execution of this Contract.
2. Precedence Among Contract Documents:
In the event of a conflict between or among the terms of the Contract Documents, the terms in the Contract Document with
the highest relative precedence shall prevail. The order of precedence shall be the order of documents as listed in
Paragraph 1, above, with the first - listed document having the highest precedence and the last - listed document having the
lowest precedence. If there are multiple Contract Amendments, the most recent amendment shall have the highest
precedence and the oldest amendment shall have the lowest precedence.
3. Effective Period:
This Contract shall be effective on July 1, 2015 and shall terminate when all funds disbursed by the Agency to the
Grantee under this Contract have been expended by the Grantee for the purposes authorized by the North Carolina
General Assembly and stated herein, unless terminated sooner under the terms of this Contract.
4. Grantee's Duties:
The North Carolina General Assembly has authorized funds to be appropriated to participating member museums of the
Grassroots Science Museums Collaborative to enhance programs and services provided by each member museum and
provide coordinated science education outreach throughout the state of North Carolina.
S. Agency's Duties:
The Agency shall pay the Grantee in the manner and in the amounts specified in the Contract Documents. The total
amount paid by the Agency to the Grantee under this Contract shall not exceed $70,268.00.
[X] a. There are no matching requirements from the Grantee.
[ ] b. The Grantee's matching requirement is $ which shall consist of:
[ ] In -kind [ ] Cash
[ ] Cash and In -kind [ ] Cash and/or In -kind
The contributions from the Grantee shall be sourced from non - federal funds.
The total contract amount is $70,268.00.
MSBNCD Form 0009A Grant Cover Sheet
Eff. 9/2005
Revised 5/06,7/07, 8/09, 7/10, 7/11, 7/12, 9/13, 8/14, 10/15 Page 1 of 15
6. Conflict of Interest Policy:
Grantee shall file with the Agency a copy of Grantee's policy addressing conflicts of interest that may arise involving the
Grantee's management employees and the members of its board of directors or other governing body. The policy shall
prohibit such individuals from directly or indirectly benefitting, (other than by receipt of any normal compensation from the
Grantee) as a result of the Grantee's disbursement of State funds, including any benefit derived from contracting with the
Grantee or owning or contracting with a sub - grantee or sub - sub - grantee. The policy shall include actions to be taken by
the Grantee, the individual or both to avoid conflicts of interest and the appearance of impropriety. The policy shall be filed
before Agency may disburse the grant funds. Additionally, every Grantee must identify for the Agency any conflicts of
interest existing under its policy prior to the execution of this Agreement and must promptly inform the Agency of any
conflict of interest of which it becomes aware during the term of this Contract.
7. Statement of No Overdue Tax Debts:
Grantee's sworn written statement pursuant to N.C.G.S. 143C- 6 -23(c) (Attachment B), stating that the Grantee does not
have any overdue tax debts, as defined by G.S. 105- 243.1, at the federal, State, or local level. A person who makes a
false statement in violation of this subsection is guilty of a criminal offense punishable as provided by N.C.G.S. 143C -10 -1.
Grantee acknowledges that the written statement must be filed before Agency may disburse the grant funds.
8. Letter of tax exempt status:
Grantee shall file with the Agency a copy of Grantee's IRS federal tax exempt letter or 501 (c) verification form.
9. Reporting Requirements:
The Agency has determined that this Contract is subject to the reporting requirements described in the attached Notice of
Certain Reporting and Audit Requirements (Attachment A), which is part of this Contract. The Grantee shall comply with
all of the reporting requirements and provisions described in Attachment A hereto.
In addition to the reporting requirements and provisions described in Attachment A, the Grantee agrees that, prior to
spending any grant funds, it shall send the Fiscal Management Division of the Agency a true and correct copy of a written,
annual budget (Attachment D) duly authorized and adopted by the Grantee's board of directors or other governing body.
Said budget shall contain a narrative description of all budgeted expenditures of grant funds, explaining howthe budgeted
expenditures would meet the objectives of the grant awarded to the Grantee and identifying any interest - bearing account
into which the Grantee has placed or intends to place any of the budgeted expenditures. Should the Grantee thereafter
revise, alter or amend said budget, it shall, within ten (10) business days thereafter, send the Fiscal Management Division
of the Agency a true and correct copy of said revised, altered or amended budget, which shall also be duly authorized and
adopted by the Grantee's board of directors or other governing body and which shall also contain a narrative description of
all budgeted expenditures of grant funds. No expenditure of grant funds maybe made by the Grantee until said budget or
revised, altered or amended budget (as applicable) has been received by the Agency.
In addition to the reporting requirements and provisions described in Attachment and the other reporting requirements
described in the preceding paragraph of this Contract, the Grantee further agrees to submit to the Agency's Fiscal
Management Division a Quarterly Expenditure Report semiannually to enable the Agency and its Fiscal Management
Division to track the status of the Grantee's expenditures of grant funds on a periodic basis. The Grantee shall continue to
complete and send said Quarterly Expenditure Reports to the Agency's Fiscal Management Division until all grant funds
received under this Contract have been expended and all such expenditures have been fully reported to the Fiscal
Management Division of the Agency. Said Quarterly Expenditure Reports shall be due and shall be delivered to the
Agency's Fiscal Management Division no later than January 31 and July 31, respectively. The Grantee shall submit a
Quarterly Expenditure Report for the first and second quarters of the State's fiscal year by January 31 and shall submit a
Quarterly Expenditure Report inclusive of the third and fourth quarters of the State's fiscal year by July 31. When
submitting said Quarterly Expenditure Reports, the Grantee shall also submit a brief narrative paragraph for each such
Report summarizing the performance objectives of expenditures and any interest earned by the Grantee from the grant
funds.
10. Payment Provisions:
Payment shall be made in accordance with N.C.G.S. 143C -6 -21 and the State's Cash Management Plan. An Annual
appropriation of more than $100,000 to or for the use of a nonprofit corporation shall be made in quarterly or monthly
payments, in the discretion of the Director of the Budget.
MSBNGD Forrn 0009A Grant Cover Sheet
Eff. 912005
Revised 5/06, 7107, 8/09, 7/10, 7/11, 7/12, 9113, 8/14, 10/15 Page 2 of 15
11. Contract Administrators:
All notices permitted or required to be given by one Party to the other and all questions about the contract from one Party to
the other shall be addressed and delivered to the other Party's Contract Administrator. The name, post office address,
street address, telephone number, fax number, and email address of the Parties' respective initial Contract Administrators
are set out below. Either Party may change the name, post office address, street address, telephone number, fax number,
or email address of its Contract Administrator by giving timely written notice to the other Party.
For the Agency
For the Grantee
IF DELIVERED BY US POSTAL SERVICE
IF DELIVERED BY US POSTAL SERVICE
Monique M. Johnson, Internal Auditor II
Sheryl Mays, Museum Director
Department of Commerce
Cape Fear Museum, Inc. cto New Hanover County
Fiscal Management Division
814 Market Street
4302 Mail Service Center
Wilmington, NC 28401 -4731
Raleigh, NC 27699
Telephone: (919) 715 -6978
Telephone: (910) 79814357
Fax: (9 19) 733 -8802
Fax: (910) 798 -4381
Email: moni ue.'ohnson nccommerce.com
Email: smays@nhcgov.com
12. Disbursements:
In addition to the other requirements set forth above and in the attached documents concerning the disbursement of grant
funds by the Grantee (including any sub - grantee(s) and sub - sub- grantee(s)), aswell as all requirements imposed on grant
fund expenditures by applicable law, rules and regulations, the Grantee acknowledges and agrees, as an express
condition of this Contract, to make disbursements of all grant funds in accordance with the following requirements:
The Grantee shall implement adequate internal controls over all disbursements;
The Grantee shall pre -audit all vouchers presented to it for payment to determine:
• The validity and accuracy of the requested payment;
• The payment due date;
• The adequacy of all documentation allegedly supporting the requested payment; and
• The legality of all disbursements and requested disbursements;
The Grantee shall assure adequate control of signature stamps and plates;
The Grantee shall assure adequate control of all negotiable instruments; and
The Grantee shall implement adequate procedures to insure that its account balance is solvent and shall
reconcile its account monthly.
13. Outsourcing:
The Grantee certifies that it has identified to the Agency all jobs related to this Contract that have been outsourced to other
states within the United States or to other countries, if any. The Grantee further acknowledges that it may not outsource to
any other state or territory or to any other country any jobs related to this Contract during the term of this Contract without
obtaining the prior written approval of the Agency.
14. Ethics Law Compliance:
The Grantee acknowledges and agrees that, in its conduct under this Contract and in connection with any and all
expenditures of grant funds made by it, the Grantee, its officers, agents and employees shall be and are subject to the
provisions of the North Carolina State Government Ethics Act, N.C. Session Law 2006 -201, House Bill 1843; Session Law
2007 -348, House Bill 1111 (the "Ethics Act "). The Grantee further acknowledges and agrees that, in the event that it
grants any of the grant funds awarded hereunder to one or more sub - grantees or sub - sub - grantees, the Grantee shall, by
contract, ensure that the provisions of the Ethics Act are made applicable to and binding upon any and all of the Grantee's
sub - grantees, sub - sub - grantees, etc.
MS &NCD Fonn 0009A Grant Cover Sheet
Eff. 912005
Revised 5/06, 7/07, 8109, 7110, 7111, 7112, 9113, 6/14, 10/15 Page 3 of 15
15. Procurement, Suspension and Debarment:
The Grantee acknowledges and agrees that, in its conduct under this Contract and in connection with any and all
expenditures of grant funds made by it, the Grantee, its officers, agents and employees shall be and are subject to the
provisions of the North Carolina General Statutes and the North Carolina Administrative Code relating to and governing
procurement, public contracts, suspension and debarment. The Grantee further acknowledges and agrees that, in the
event that it grants any of the grant funds awarded hereunder to one or more sub - grantees or sub - sub - grantees, the
Grantee shall, by contract, ensure that the provisions of the North Carolina General Statutes and the North Carolina
Administrative Code relating to and governing procurement, public contracts, suspension and debarment are made
applicable to and binding upon any and all of the Grantee's sub - grantees, sub - sub - grantees, etc.
16. Cost Principles:
The Grantee acknowledges and agrees that, in its conduct under this Contract and in connection with any and all
expenditures of grant funds made by it, it shall comply with the cost principles enunciated in 2 CFR Part 200 Subpart E —
Cost Principles (htto: / /www.ecfr.a . The Grantee further acknowledges and agrees that, in the event that it grants any
of the grant funds awarded hereunder to one or more sub - grantees or sub - sub - grantees, the Grantee shall, by contract,
ensure that said cost principles are made applicable to and binding upon any and all such sub - grantees, sub -sub-
grantees, etc. in their handling, use and expenditure of the funds awarded to the Grantee hereunder.
17. Final Reports and Certifications:
The Grantee shall file all reports and certifications, as described and required by Attachment A to this Contract, concerning
its receipt, handling and expenditure of all grant funds awarded hereunder, including any interest earned by the Grantee
from such funds, with the Fiscal Management Division of the Agency.
18. Monitoring and Auditing:
The Grantee acknowledges and agrees that, from and after the date of execution of this Contract and for five (5) years
following its termination, the books, records, documents and facilities of the Grantee are subject to being audited,
inspected and monitored at any time by the Agency upon its request (whether in writing or otherwise). The Grantee and
its officers, agents and employees shall make the Grantee's books, records, documents and offices/facilities available to
the Agency and its personnel for inspection, audit and monitoring upon the Agency's request, shall answer any questions
posed to them by the Agency and shall provide the Agency, upon its request, with any documents, records or information
sought by the Agency in its efforts to monitor and audit the Grantee's activities regarding the funds awarded under this
Contract. The Grantee further agrees to keep and maintain all of its books, records and documents relating in any way to
the grant funds awarded hereunder for the time period specified in Attachment C hereto.
19. Grant Agreement With Sub - Grantee(s):
In the event that the Grantee grants to a sub - grantee, a sub - sub - grantee, etc. any of the grant funds awarded to the
Grantee hereunder, the Grantee must retain a signed copy of the contract or letter pursuant to which the grant funds
awarded to the Grantee hereunder are granted to a sub - grantee, a sub - sub - grantee, etc.
20. Repayment of Grant Funds to Agency:
In the event that the Grantee, either directly or indirectly (e.g., through a sub - grantee or sub - sub - grantee) commits any
breach of this Contract which the Grantee fails to fully cure within thirty (30) days of its receipt of written notice from the
Agency of said breach, the Agency may make demand in writing of the Grantee that it repay the Agency so much of the
grant funds awarded underthis Contract, up to and including 100 %of the amount of the award made underthis Contract.
In such an event, the Grantee shall repay said amount to the Agency within thirty (30) days of its receipt of said demand
for repayment, as well as any interest earned by the Grantee on said amount.
In addition, in the event that this Contract should be terminated by the parties or otherwise comes to an end prior to the
time when the Grantee, its sub - grantee(s), any sub - sub - grantee(s), etc. have expended all of the funds awarded underthis
Contract, the Grantee shall, within thirty (30) days of said termination or contract end, return to the Agency all such
unexpended funds as well as any interest earned by the Grantee on such funds. Furthermore, the Grantee shall, by
contract, ensure that, in the event that its sub - grantee(s) enter into any sub - sub -grant agreements involving any of the
funds awarded hereunder, all such sub-grantees, sub - sub - grantees, etc. are required to repay to their grantee(s) all such
unexpended funds, as well as any interest earned by the sub - grantee or sub - sub - grantee on such funds, so that the
Grantee can return those unexpended funds and interest to the Agency within thirty (30) days of the termination or other
end of this Contract. In any event, the Grantee shall be and remain liable to the Agency for the repayment to the Agency
of all grant funds that are unexpended (either by the Grantee or any sub - grantee, sub - sub - grantee, etc.) at the time of the
termination or other end of this Contract, as well as the repayment of any interest earned by the Grantee, sub - grantee or
sub - sub - grantee on such funds at that time.
MS &NCD Form 0009A Grant Cover Sheet
Eff. 9/2005
Revised 5/06, 7/07, 8109, 7/10, 7/11, 7/12, 9113, 8114, 10115 Page 4 of 15
21. Termination:
Subject to the provisions of paragraph 20 of this Contract, this Contract may
be terminated in accordance with the
provisions set forth in Attachment C hereto, however, the reporting, monitoring and audit requirements and provisions of
this Contract shall survive any such termination.
22. Authorized Signature Warranty:
The undersigned represent and warrant that they are authorized to bind their
principals to the terms of this agreement.
In Witness Whereof, the Grantee and the Agency have executed this Contract in
duplicate originals, with one original being
retained by each party.
Cape Fear us u Inc. c% New.l�anover County
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Sign ture
Date
('�u,A44 ►Uin� ar
Printed Name
Ti e
ATTEST
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otary Public I
Datb N tarized
Printed Nark)
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Title u',rC�,,'•'•.
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[OFFICIAL SEAL]
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North Carolina Department of Commerce
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Signature
ate
Heather Horton
Chief Fiscal Officer
Printed Name
Title
MSBNCD Form 0009A Grant Cover Sheet
Eff. 9/2005
Revised 5/06, 7107, 8/09, 7/10, 7111, 7/12, 9113, 8114, 10115 Page 5 of 15
Attachment A
Notice of Certain Reporting and Audit Requirements
Grantee shall comply with all the rules and reporting requirements established by statute or administrative rules.
For convenience, the requirements of G.S. 159 -34 are set forth in this Attachment.
§ 159 -34. Annual independent audit; rules and regulations.
(a) Each unit of local government and public authority shall have its accounts audited as soon as possible after the close
of each fiscal year by a certified public accountant or by an accountant certified by the Commission as qualified to
audit local government accounts. When specified by the secretary, the audit shall evaluate the performance of a unit
of local government or public authority with regard to compliance with all applicable federal and State agency
regulations. This audit, combined with the audit of financial accounts, shall be deemed to be the single audit described
by the "Federal Single Audit Act of 1984 ". The auditor shall be selected by and shall report directly to the governing
board. The audit contract or agreement shall (i) be in writing, (ii) include the entire entity in the scope of the audit,
except that an audit for purposes other than the annual audit required by this section should include an accurate
description of the scope of the audit, (iii) require that a typewritten or printed report on the audit be prepared as set
forth herein, (iv) include all of its terms and conditions, and (v) be submitted to the secretary for his approval as to
form, terms, conditions, and compliance with the rules of the Commission. As a minimum, the required report shall
include the financial statements prepared in accordance with generally accepted accounting principles, all disclosures
in the public interest required by law, and the aud'itor's opinion and comments relating to financial statements. The
audit shall be performed in conformity with generally accepted auditing standards. The finance officer shall file a copy
of the audit report with the secretary, and shall submit all bills or claims for audit fees and costs to the secretary for his
approval. Before giving his approval the secretary shall determine that the audit and audit report substantially conform
to the requirements of this section. It shall be unlawful for any unit of local government or public authority to pay or
permit the payment of such bills or claims without this approval. Each officer and employee of the local government or
local public authority having custody of public money or responsibility for keeping records of public financial or fiscal
affairs shall produce all books and records requested by the auditor and shall divulge such information relating to fiscal
affairs as he may request. If any member of a governing board or any other public officer or employee shall conceal,
falsify, or refuse to deliver or divulge any books, records, or information, with an attempt thereby to mislead the auditor
or impede or interfere with the audit, he is guilty of a Class 1 misdemeanor.
(b) The Local Government Commission has authority to issue rules and regulations for the purpose of improving the
quality of auditing and the quality and comparability of reporting pursuant to this section or any similar section of the
General Statutes. The rules and regulations may consider the needs of the public for adequate information and the
performance that the auditor has demonstrated in the past, and may be varied according to the size, purpose or
function of the unit, or any other criteria reasonably related to the purpose or substance of the rules or regulation.
(c) Notwithstanding any other provision of law, except for Article 5A of Chapter 147 of the General Statutes pertaining to
the State Auditor, all State departments and agencies shall rely upon the single auditaccepted bythesecretary asthe
basis forcompliance with applicable federal and State regulations. All State departments and agencies which provide
funds to local governments and public authorities shall provide the Commission with documents thatthe Commission
finds are in the prescribed format describing standards of compliance and suggested audit procedures sufficient to
give adequate direction to independent auditors retained by local governments and public authorities to conduct a
single audit as required by this section. The secretary shall be responsible for the annual distribution of all such
standards of compliance and suggested audit procedures proposed by State departments and agencies and any
amendments thereto. Further, the Commission with the cooperation of all affected State departments and agencies
shall be responsible for the following:
(1) Procedures for the timely distribution of compliance standards developed by State departments and agencies,
reviewed and approved by the Commission to auditors retained by local governments and public authorities.
(2) Procedures for the distribution of single audits for local governments and public authorities such that they are
available to all State departments and agencies which provide funds to local units.
(3) The acceptance of single audits on behalf of all State departments and agencies; provided that, the secretary may
subsequently revoke such acceptance for cause, whereupon affected State departments and agencies shall no
longer rely upon such audit as the basis for compliance with applicable federal and State regulations. (1971, c.
780, s. 1; 1975, c. 514, s. 15; 1979, c. 402, s. 9; 1981, c. 685, ss. 8, 9; 1987, c. 287; 1993, c. 257, s. 20; c. 539, s.
1081; 1994, Ex. Sess., c. 24, s. 14(c); 2001 -160, s. 1.)
NGO Form 0008 Page 6 of 15
Eff. July 1, 2005
Revised 7/2007, 8/2009, 712010, 7/2011, 9/2013, 10/2015
aVSTY.�
NEW HANOVER COUNTY ¢ ' o�
FINANCE DEPARTMENT 0 y
230 Government Center Drive 2 n
Suite 165 t O
Wilmington, NC 28403 `
VA 2
Telephone: (910) 798 -7187 Z a
Fax: (910) 798 -7806 q.
•f��BLISFiE� ��
To: State Agency Head and Chief Fiscal Officer
Certification:
Lisa Wurtzbacher, CPA
Chief Financial Officer
Barbara D. McClure, CPA
Deputy Chief Financial Officer
Jennifer R. Maready, CPA
Deputy Chief Financial Officer
We certify that New Hanover County does not have any overdue tax debts, as defined
by N.C.G.S. 105 - 243.1, at the federal, State, or local level. We further understand that
any person who makes a false statement in violation of N.C.G.S. 143C- 6 -23(c) is guilty
of a criminal offense punishable as provided by N.C.G.S. 143- 34(b).
Sworn Statement:
Jonathan Barfield, Jr. and Lisa Wurtzbacher being duly sworn, say that we are the
Board Chair and Chief Financial Officer, respectively, of New Hanover County of
Wilmington in the State of North Carolina; and that the foregoing certification is true,
accurate and complete to the best of our knowledge and was made and subscribed by
us. We also acknowledge and understand that any misuse of State funds will be
reported to thegppropriate authorities for further action.
J�than Barfier, Jr., Chairman
'9a6� W d
Lisa Wurtzbacher, Chief Financial Officer
Sworn to and subscribed before me on the day of November, 2015.
�<6" a. 2%0 ll �/ My Commission Expire C
(N tary Sign re and Seal)
Website: w .nhc og v.com
Professionalism I Integrity I Innovation I Stewardship I Accountability
PRIVATE SECTOR CONTRACTS
Attachment C
General Terms and Conditions
DEFINITIONS
Unless indicated otherwise from the context, the following
terms shall have the following meanings in this Contract.
All definitions are from 9 NCAC 3M.0102 unless otherwise
noted. If the rule or statute that is the source of the
definition is changed by the adopting authority, the change
shall be incorporated herein:
(1) "Agency" (as used in the context of the definitions
below) shall mean and include every public office,
public officer or official (State or local, elected or
appointed), institution, board, commission, bureau,
council, department, authority or other unit of
government of the State or of any county, unit,
special district or other political subagency of
government. For other purposes in this Contract,
"Agency" shall mean the entity identified as one of
the parties hereto.
(2) "Audit" means an examination of records or
financial accounts to verify their accuracy.
(3) "Certification of Compliance" means a report
provided by the Agency to the Office of the State
Auditor that states that the Grantee has met the
reporting requirements established by this
Subchapter and included a statement of
certification by the Agency and copies of the
submitted grantee reporting package.
(4) "Compliance Supplement" refers to the North
Carolina State Compliance Supplement,
maintained by the State and Local Government
Finance Agency within the North Carolina
Department of State Treasurer that has been
developed in cooperation with agencies to assist
the local auditor in identifying program compliance
requirements and audit procedures for testing
those requirements.
(5) "Contract" means a legal instrument that is used to
reflect a relationship between the agency, grantee,
and subgrantee.
(6) "Fiscal Year" means the annual operating year of
the non -State entity.
(7) "Financial Assistance" means assistance that non-
State entities receive or administer in the form of
grants, loans, loan guarantees, property (including
donated surplus property), cooperative
agreements, interest subsidies, insurance, food
commodities, direct appropriations, and other
assistance. Financial assistance does not include
amounts received as reimbursement for services
rendered to individuals for Medicare and Medicaid
patient services.
(8) "Financial Statement" means a report providing
financial statistics relative to a given part of an
organization's operations or status.
(9) "Grant" means financial assistance provided by an
agency, grantee, or subgrantee to carry out
NGO Form 000981 Grants General Terms and Conditions - Private Entities
Eff. 912005
Revised 7/2007, 7/2012,10/2015
activities whereby the grantor anticipates no
programmatic involvement with the grantee or
subgrantee during the performance of the grant.
(10) "Grantee" has the meaning in G.S. 143C -6-
23(a)(2): A non -State entity that receives a grant
of State funds from a State agency, department,
or institution but does not include any non -State
entity subject to the audit and other reporting
requirements of the Local Government
Commission. For other purposes in this Contract,
"Grantee" shall mean the entity identified as one of
the parties hereto.
(1 1)"Grantor"means an entitythat provides resources,
generally financial, to another entity in order to
achieve a specified goal or objective.
(12) "Non -State Entity" has the meaning in N.C.G.S.
143C- 1- 1(d)(18): Any of the following that is not a
State agency: An individual, a firm, a partnership,
an association, a county, a corporation, or any
other organization acting as a unit. The term
includes a unit of local government and public
authority.
(13) "Public Authority" has the meaning in N.C.G.S.
143C- 1- 1(d)(22): A municipal corporation that is
not a unit of local government or a local
governmental authority, board, commission,
council, or agency that (i) is not a municipal
corporation and (ii) operates on an area, regional,
or multiunit basis, and the budgeting and
accounting systems of which are not fully a part of
the budgeting and accounting systems of a unit of
local government.
(14) "Single Audit" means an audit that includes an
examination of an organization's financial
statements, internal controls, and compliance with
the requirements of Federal or State awards.
(15) "Special Appropriation" means a legislative act
authorizing the expenditure of a designated
amount of public funds for a specific purpose.
(16) "State Funds" means any funds appropriated by
the North Carolina General Assembly or collected
by the State of North Carolina. State funds
include federal financial assistance received by
the State and transferred or disbursed to non -
State entities. Both Federal and State funds
maintain their identity as they are subgranted to
other organizations. Pursuantto N.C.G.S. 143C -6-
23(a)(1), the terms "State grant funds" and "State
grants" do not include any payment made by the
Medicaid program, the State Heafth Plan for
Teachers and State Employees, or other similar
medical programs.
(17) "Subgrantee" has the meaning in G.S. 143C -6-
23(a)(4): A non -State entity that receives State
funds as a grant from a grantee or from another
Page 8 of 15
subgrantee but does not include any non -State
entity subject to the audit and other reporting
requirements of the Local Government
Commission.
(18) "Unit of Local Government has the meaning in
G.S. 143C- 1- 1(d)(29): A municipal corporation
that has the power to levy taxes, including a
consolidated citycounty as defined by G.S. 1606-
2(1), and all boards, agencies, commissions,
authorities, and institutions thereof that are not
municipal corporations.
Relationships of the Parties
Independent Contractor: The Grantee is and shall be
deemed to be an independent contractor in the
performance of this Contract and as such shall be wholly
responsible for the work to be performed and for the
supervision of its employees. The Grantee represents that
it has, or shall secure at its own expense, all personnel
required in performing the services under this agreement.
Such employees shall not be employees of, or have any
individual contractual relationship with, the Agency.
Subcontracting and Subgranting: Any subcontracts or
subgrants entered into by the Grantee with grant funds
shall be subject to all conditions of this Contract. Payment
of all subcontractors and subgrantees shall be the sole
responsibility of the Grantee, and the Agency shall not be
obligated to pay for any work performed by any
subcontractor or subgrantee. The Grantee shall be
responsible for the performance of all subcontractors and
subgrantees and shall not be relieved of any of the duties
and responsibilities of this Contract as a result of entering
into subcontracts or subgrants. Additionally, if said
Grantee subgrants any grant funds pursuant to this
Contract, the Grantee shall submit a copy of its policies
and /or procedures for monitoring subgrantees to the
Agency.
Subgrentees: The Grantee has the responsibility to
ensure that all subgrantees, if any, provide all information
necessary to permit the Grantee to comply with the
standards set forth in this Contract.
Assignment: No assignment ofthe Grantee's obligations
or the Grantee's right to receive payment hereunder shall
be permitted. However, upon written request approved by
the issuing purchasing authority, the State may:
(a) Forward the Grantee's payment check(s) directly
to any person or entity designated by the Grantee,
or
(b) Include any person or entity designated by
Grantee as a joint payee on the Grantee's
payment check(s).
In no event shall such approval and action obligate the
State to anyone other than the Grantee and the Grantee
shall remain responsible for fulfillment of all contract
obligations.
NGO Form 000981 Grants General Terms and Conditions- Private Entities
Eff. 9/2005
Revised 7/2007, 7/2012,10/2015
Beneficiaries: Except as herein specifically provided
otherwise, this Contract shall inure to the benefit of and be
binding upon the parties hereto and their respective
successors. It is expressly understood and agreed that the
enforcement of the terms and conditions of this Contract,
and all rights of action relating to such enforcement, shall
be strictly reserved to the Agency and the named Grantee.
Nothing contained in this document shall give or allow any
claim or right of action whatsoever by any other third
person. It is the express intention of the Agency and
Grantee that any such person or entity, other than the
Agency or the Grantee, receiving services or benefits
under this Contract shall be deemed an incidental
beneficiary only.
Indemnity and Insurance
Indemnification: The Grantee agrees to indemnify and
hold harmless the Agency, the State of North Carolina, and
any of their officers, agents and employees, from any
claims of third parties arising out of any act or omission of
the Grantee in connection with the performance of this
Contract.
Insurance: During the term of the contract, the Grantee at
its sole cost and expense shall provide commercial
insurance of such type and with such terms and limits as
may be reasonably associated with the contract. As a
minimum, the Grantee shall provide and maintain the
following coverage and limits:
(a) Worker's Compensation - The grantee shall
provide and maintain Worker's Compensation
Insurance as required by the laws of North
Carolina, as well as employers liability coverage
with minimum limits of $500,000.00, covering all of
Grantee's employees who are engaged in any
work under the contract. If any work is sublet, the
Grantee shall require the subgrantee to provide
the same coverage for any of his employees
engaged in any work under the contract.
(b) Commercial General Liability - General Liability
Coverage on a Comprehensive Broad Form on an
occurrence basis in the minimum amount of
$1,000,000.00 Combined Single Limit. (Defense
cost shall be in excess of the limit of liability.)
(c) Automobile - Automobile Liability Insurance, to
include liability coverage, covering all owned,
hired and non -owned vehicles used in
performance of the contract. The minimum
combined single limit shall be $500,000.00 bodily
injury and property damage; $500,000.00
uninsured /under insured motorist; and $25,000.00
medical payment.
Providing and maintaining adequate insurance coverage is
a material obligation of the Grantee and is of the essence
of this Contract. The Grantee may meet its requirements
of maintaining specked coverage and limits by
demonstrating to the Agency that there is in force
insurance with equivalent coverage and limits that will offer
Page 9 of 15
at least the same protection to the Agency. All such
insurance shall meet all laws of the State of North
Carolina. Such insurance coverage shall be obtained from
companies that are authorized to provide such coverage
and that are authorized by the Commissioner of Insurance
to do business in North Carolina. The Grantee shall at all
times comply with the terms of such insurance policies,
and all requirements of the insurer under any such
insurance policies, except as they may conflict with
existing North Carolina laws or this Contract. The limits of
coverage under each insurance policy maintained by the
Grantee shall not be interpreted as limiting the grantee's
liability and obligations under the contract.
Default and Termination
Termination by Mutual Consent: The Parties may
terminate this Contract by mutual consent with 60 days
notice to the other party, or as otherwise provided by law.
Termination for Cause: If, through any cause, the
Grantee shall fail to fulfill its obligations underthis Contract
in a timely and proper manner, the Agency shall have the
right to terminate this Contract by giving written notice to
the Grantee and specifying the effective date thereof. In
that event, all finished or unfinished deliverable items
prepared by the Grantee under this Contract shall, at the
option of the Agency, become its property and the Grantee
shall be entitled to receivejust and equitable compensation
for any satisfactory work completed on such materials,
minus any payment or compensation previously made.
Notwithstanding the foregoing provision, the Grantee shall
not be relieved of liability to the Agency for damages
sustained by the Agency by virtue of the Grantee's breach
of this agreement, and the Agency may withhold any
payment due the Grantee for the purpose of setoff until
such time as the exact amount of damages due the
Agency from such breach can be determined. The filing of
a petition for bankruptcy by the Grantee shall be an act of
default under this Contract.
Waiver of Default: Waiver by the Agency of any default
or breach in compliance with the terms of this Contract by
the Grantee shall not be deemed a waiver of any
subsequent default or breach and shall not be construed to
be modification of the terms of this Contract unless stated
to be such in writing, signed by an authorized
representative of the Agency and the Grantee and
attached to the contract.
Availability of Funds: The parties to this Contract agree
and understand that the payment of the sums specified in
this Contract is dependent and contingent upon and
subject to the appropriation, allocation, and availability of
funds for this purpose to the Agency.
Force Majeure: Neither party shall be deemed to be in
default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of
war, hostile foreign action, nuclear explosion, riot, strikes,
civil insurrection, earthquake, hurricane, tornado, or other
catastrophic natural event or act of God.
Survival of Promises: All promises, requirements, terms,
conditions, provisions, representations, guarantees, and
warranties contained herein shall survive the contract
expiration or termination date unless specifically provided
otherwise herein, or unless superseded by applicable
federal or State statutes of limitation.
Intellectual Property Rights
Copyrights and Ownership of Deliverables: Any
deliverable items produced for use by the Agency pursuant
to this Contract are the exclusive property of the Agency.
The Grantee shall not assert a claim of copyright or other
property interest in such deliverables.
Federal Intellectual Property Bankruptcy Protection
Act: The Parties agree that the Agency shall be entitled to
all rights and benefits of the Federal Intellectual Property
Bankruptcy Protection Act, Public Law 100 -506, coded at
11 U.S.C. 365 (n) and any amendments thereto.
Compliance with Applicable Laws
Compliance with Laws: The Grantee shall comply with
all laws, ordinances, codes, rules, regulations, and
licensing requirements that are applicable to the conduct of
its business, including those of federal, state, and local
agencies having jurisdiction and /or authority.
Equal Employment Opportunity: The Grantee shall
comply with all federal and State laws relating to equal
employment opportunity.
Confidentiality
Confidentiality: To the extent that any information or
documents provided to the Agency by or on behalf of the
Grantee, or to the Grantee by or on behalf of the Agency,
would be regarded as confidential or not subject to
disclosure under federal law orthe North Carolina General
Statutes (to include, without limitation, N.C. Gen. Stat. §
132 -1 at seq., commonly referred to as the "Public Records
Act"), the party providing the information or documents
shall clearly identify and mark it or them as such and that
information or those documents will, to the extent allowed
by law, be treated as confidential and not subject to
disclosure by party receiving it. To the extent the Agency
provides information to the Grantee concerning confidential
and unannounced business location or expansion projects,
the Grantee agrees to keep such information confidential
until such time as the Agency releases that information to
the public. The Grantee has read and understands North
Carolina's laws regarding the treatment of public records
and confidential information. Anything that qualifies as a
trade secret under North Carolina law must be designated
as "confidential" or "trade secret" at the time of initial
NGO Fonn 000981 Grants General Terms and Conditions- Private Entities
Eff. 9/2005
Revised 7/2007, 7/2012, 10/2015 Page 10 of 15
disclosure to the Agency, or it is considered a public record
under State law.
Oversight
Access to Persons and Records: The State Auditor
shall have access to persons and records as a result of all
contracts or grants entered into by State agencies or
political subdivisions in accordance with N.C.G.S. 147-
64.7. Additionally, as the State funding authority, the
Agency shall have access to persons and records as a
result of all contracts or grants entered into by State
agencies or political subdivisions.
Record Retention: The Grantee will comply with State
basic records retention policy standards. State basic
records retention policy requires all grant records to be
retained for a minimum of five years or until all audit
exceptions have been resolved, whichever is longer. If the
contract is subject to federal policy and regulations, record
retention may be longer than five years since records must
be retained for a period of three years following submission
of the final Federal Financial Status Report, if applicable,
or three years following the submission of a revised final
Federal Financial Status Report. Also, if any litigation,
claim, negotiation, audit, disallowance action, or other
action involving this Contract has been started before
expiration of the five -year retention period described
above, the records must be retained until completion of the
action and resolution of all issues which arise from it, or
until the end of the regular five -year period described
above, whichever is later.
Miscellaneous
Choice of Law: The validity of this Contract and any of its
terms or provisions, as well as the rights and duties of the
parties to this Contract, are governed by the laws of North
Carolina. The Grantee, by signing this Contract, agrees
and submits, solely for matters concerning this Contract, to
the exclusive jurisdiction of the courts of North Carolina
and agrees, solely for such purpose, that the exclusive
venue for any legal proceedings shall be Wake County,
North Carolina. The place of this Contract and all
transactions and agreements relating to it, and their situs
and forum, shall be Wake County, North Carolina, where
all matters, whether sounding in contract ortort, relating to
the validity, construction, interpretation, and enforcement
shall be determined.
Amendment: This Contract may not be amended orally or
by performance. Any amendment must be made in written
form and executed by duly authorized representatives of
the Agency and the Grantee.
Severability: In the event that a court of competent
jurisdiction holds that a provision or requirement of this
Contract violates any applicable law, each such provision
or requirement shall continue to be enforced to the extent it
is not in violation of law or is not otherwise unenforceable
and all other provisions and requirements of this Contract
shall remain in full force and effect.
Headings: The Section and Paragraph headings in these
General Terms and Conditions are not material parts ofthe
agreement and should not be used to construe the
meaning thereof.
Time of the Essence: Time is of the essence in the
performance of this Contract.
Certification Regarding Collection of Taxes: N.C.G.S.
143 -59.1 bars the Secretary of Administration from
entering into contracts with vendors that meet one of the
conditions of N.C.G.S. 105- 164.8(b) and yet refuse to
collect use taxes on sales of tangible personal property to
purchasers in North Carolina. The conditions include: (a)
maintenance of a retail establishment or office; (b)
presence of representatives in the State that solicit sales or
transact business on behalf of the vendor; and (c)
systematic exploitation of the market by media - assisted,
media - facilitated, or media - solicited means. The Grantee
certifies that it and all of its affiliates (if any) collect all
required taxes.
Care of Property: The Grantee agrees that it shall be
responsible for the proper custody and care of any
property furnished to it for use in connection with the
performance of this Contract and will reimburse the
Agency for loss of, or damage to, such property. At the
termination of this Contract, the Grantee shall contact the
Agency for instructions as to the disposition of such
property and shall comply with these instructions.
Travel Expenses: Reimbursement to the Grantee for
travel mileage, meals, lodging and other travel expenses
incurred in the performance of this Contract shall be
reasonable and supported by documentation. State rates
should be used as guidelines.
Sales/Use Tax Refunds: If eligible, the Grantee and all
subgrantees shall: (a) ask the North Carolina Department
of Revenue for a refund of all sales and use taxes paid by
them in the performance of this Contract, pursuant to
N.C.G.S. 105- 164.14; and (b) exclude all refundable sales
and use taxes from all reportable expenditures before the
expenses are entered in their reimbursement reports.
Advertising: The Grantee shall not use the award of this
Contract as a part of any news release or commercial
advertising.
NGO Form 0009B1 Grants General Terms and Conditions- Private Entities
Eff. 9/2005
Revised 7/2007, 712012, 1012015 Page 11 of 15
Attachment D
Annual Budget
Before it will be possible to finalize this award and make any disbursement, you are required to provide to the Department
of Commerce Fiscal Management Division a detailed description and timeline for how the organization will spend the
amount of funding allocated for the specific purpose as stated in the grant contract as follows:
Below are general expenditure descriptions that can serve as a guide for preparing the organization's annual budget.
Please add or delete expenditure captions for clarity if needed. The Annual Budget must be signed by the Board
Chairman and the Board Treasurer or Other Authorizing Official.
The Following Annual Budget is for the time period beginning July 1. 2015 and ending June 30, 2016.
EXPENDITURE DESCRIPTION AMOUNT
PERSONAL SERVICES $
Salaries & Wages $51,296
Fringe Benefits $18,972
Other Personal Services $
PURCHASED SERVICES
Travel
Communications /Data Processing
Postage/Freight/Deliveries
Printing /Advertising
Repairs /Maintenance /Utilities
Contracted Services
Other Services
SUPPLIES & MATERIALS
General Administrative Supplies
$
Other Administrative Expenses
$
FIXED CHARGES & EXPENSES
Rent/Leases
$
Insurance /Bonding
$
Other Fixed Charges /Expenses
$
CAPITAL OUTLAY
Office Equipment
$
Office Furniture
$
Building /Other Structures /Improvements
$
Land
$
Motor Vehicles
$
Other Capital Outlay
$
GRANTS
Grants to Other Entities (Sub- Awards)
$
DEBT SERVICE
Principal Payments
$
Interest Payments
$
OTHER EXPENDITURES
Other Expenditures
$
TOTAL BUDGETED EXPENDITURES
$70,268
With regard to the information contained herein, I certify that the annual budget has been approved by the Grantee's
governing board and that any future budget adjustments will be approved by the Board and provided in writing to
the Fiscal Management Division of the North Carolina Department of Commerce.
Board
Signal
Board
Signal
Attachment E
Session Law 2015 -241, House Bill 97 Section 6.26 and 15.18
CAP STATE FUNDED PORTION OF NONPROFIT SALARIES
SECTION 6.26. No more than one hundred twenty thousand dollars ($120,000) in State funds may be used for the annual
salary of any individual employee of a nonprofit organization receiving State funds. For the purposes of this section, the term
"State funds" means funds as defined in G.S. 143C- 1- 1(d)(25) and any interest earnings that accrue from those funds.
GRASSROOTS SCIENCE PROGRAM
SECTION 15.18.(a) Of the funds appropriated in this act to the Department of Commerce for State -Aid, the sum of two
million four hundred forty-eight thousand four hundred thirty dollars ($2,448,430) is allocated as grants -in -aid forthe 2015-
2016 fiscal year:
2015 -2016
Aurora Fossil Museum
$60,122
Cape Fear Museum
$70,268
Carolina Raptor Center
$70,243
Catawba Science Center
$80,864
Colburn Earth Science Museum, Inc.
$61,154
Core Sound Waterfowl Museum
$65,052
Cowan Museum of History and Science
$58,598
Dan Nicholas Park (Rowan County)
$58,000
Discovery Place
$240,166
Discovery Place KIDS (Rockingham)
$58,000
Eastern NC Regional Science Center
$59,072
Fascinate -U
$63,355
Granville County Museum Commission,
Inc. - Harris Gallery
$59,872
Greensboro Children's Museum
$73,823
Greensboro Science Center
108,118
Hands On! -A Child's Gallery
$60,634
Highlands Nature Center
$61,140
Imagination Station
$62,895
The Iredell Museums, Inc.
$59,776
Kidsenses
$61,604
Marbles Kids Museum
$120,050
Museum of Coastal Carolina
$63,510
North Carolina Estuarium
$60,837
North Carolina Museum of Life
$151,898
and Science
Pisgah Astronomical Research Institute
$74,592
Port Discover: Northeastern
North Carolina's Center for
Hands -On Science, Inc.
$59,844
Rocky Mount Children's Museum
$62,636
Schiele Museum of Natural History
and Planetarium, Inc.
$85,646
Sci Works Science Center and
Environmental Park of Forsyth County
$77,444
Sylvan Heights Waterfowl Park
and Eco- Center
$66,238
Western North Carolina Nature Center
$67,336
Wilmington Children's Museum
$65,643
Total
$2,448,430
SECTION 15.18.(b) No later than March 1, 2016, the Department of Commerce shall report to the Fiscal Research
Division all of the following information for each museum that receives funds under this section:
(1) For museums that operate on a fiscal year, the actual operating budget for the 2014 -2015 fiscal year. For
museums that operate on a calendar year, the actual operating budget for the 2014 calendar year.
(2) The proposed operating budget for the 2015 -2016 fiscal year.
(3) The total attendance at the museum during the 2015 calendar year.
Page 13 of 15
Attachment E
Session Law 2015 -241, House Bill 97 Section 15.18 (Continued)
SECTION 15.18.(c) As a condition for qualifying to receive funding under this section, all of the following documentation
shall, no later than November 1, 2015, be submitted for each museum under this section to the Department of Commerce for
the fiscal year that most recently ended and only those costs that are properly documented under this subsection are
allowed by the Department in calculating the distribution of funds under this section:
(1) Each museum under this section shall submit its Internal Revenue Service (IRS) Form 990 to show its annual
operating expenses, its annual report, and a reconciliation that explains any differences between expenses as
shown on the IRS Form 990 and the annual report.
(2) Each friends association of a museum under this section shall submit its IRS Form 990 to show its reported
expenses for the museum, its annual report, and a reconciliation that explains any differences between expenses
as shown on the IRS Form 990 and the annual report, unless the association does not have both an IRS Form
990 and an annual report available; in which case, it shall submit either an IRS Form 990 or an annual report.
(3) The chief financial officer of each county or municipal government that provides funds for the benefit of the
museum shall submit a detailed signed statement of documented costs spent for the benefit of the museum that
includes documentation of the name, address, title, and telephone numberof the person making the assertion that
the museum receives funds from the county or municipality for the benefit of the museum.
(4) The chief financial officer of each county or municipal government or each friends association that provides
indirect or allocable costs that are not directly charged to a museum under this section but that benefit the
museum shall submit in the form of a detailed statement enumerating each cost by type and amount that is
verified by the financial officer responsible for the completion of the documentation and that includes the name,
address, title, and telephone number of the person making the assertion that the county, municipality, or
association provides indirect or allocable costs to the museum.
SECTION 15.18.(d) As used in subsection (c) of this section, 'friends association" means a nonprofit corporation
established for the purpose of supporting and assisting a museum that receives funding under this section.
SECTION 15.18.(e) Each museum listed in subsection (a) of this section shall do the following:
(1) By September 1, 2016, and more frequently as requested, report to the Joint Legislative Commission on
Governmental Operations and the Fiscal Research Division on prior State fiscal year program activities,
objectives, and accomplishments and prior State fiscal year itemized expenditures and fund sources.
(2) Provide to the Fiscal Research Division a copy of the museum's annual audited financial statement within 30
days of issuance of the statement.
GRASSROOTS SCIENCE PROGRAM /COMPETITIVE GRANT PROGRAM
SECTION 15.18A.(a) Effective July 1, 2016, the Grassroots Science Program within the Department of Commerce is
transferred to the North Carolina State Museum of Natural Sciences in the Department of Natural and Cultural Resources,
as enacted by Section 14.30 of this act.
SECTION 15.18A.(b) Part 40 of Article 2 of Chapter 143B of the General Statutes, as enacted by Section 14.30 of this
act, is amended by adding a new section to read as follows:
section snau apply to the two -year grants
(d) To be eligible to receive a grant under the competitive grant grogram a museum shall demonstrate
Page 14 of 15
Attachment E
Session Law 2015 -241, House Bill 97 Section 15.18 (Concluded)
(1) That it is a science center or museum or a children's museum that is physically located in the State.
(2) That it has been open, operating, and exhibiting science or science, technology, engineering, and math (STEM)
education objects to the general public at least 120 days of each year for the past two or more years.
(3) That it is a nonprofit organization that is exempt from federal income taxes pursuant to section 501(c)(3) of the
Internal Revenue Code.
(4) That it has on its staff at least one full -time professional person.
(5) That its governing body has adopted a mission statement that includes language that shows the museum has a
concentration on science or STEM education and that the adopted mission statement has been in effect for the
past two or more years.
j1 The Museum of Natural Sciences shall, in awarding grants under this section, give priority to museums that:
(1) When compared to other museum applicants:
a.Are located in counties that are more economically distressed according to the annual rankings
Prepared by the Department of Commerce pursuant to G.S. 1436 -437.08(c).
b.Generate a larger portion of their operating funds from non -State revenue.
c. Have a higher attendance -to- population ratio.
(2) Partner with other museums in the State to share exhibits, programs, or other activities.
(3) Are not located in close proximity to other science or STEM education museums."
SECTION 15.18A.(c) Subsection (b) of this section becomes effective July 1, 2016.
SECTION 15.18A.(d) By March 1, 2016, the Museum of Natural Sciences shall submit guidelines for the submission of
applications and the awarding of grants for the competitive grant program provided for in subsection (b) of this section to the
chairs of the House of Representatives Appropriations Committee on Agriculture and Natural and Economic Resources and
the Senate Appropriations Committee on Natural and Economic Resources and the Fiscal Research Division.
Page 15 of 15
OSBM — 10/07
REQUEST FOR PAYMENT OF APPROPRIATION(S) FROM NORTH CAROLINA GENERAL FUND
(SEE LETTER ENCLOSED)
2015 -15 Allocation: $ 70,268
Purpose: Grassroots Science Museums Collaborative appropriation for Cape Fear Museum
Part A. TO BE COMPLETED BY ALL RECIPIENTS
1. Contact's Name: Lisa Wurtzbacher Telephone: 910 - 798 -7187
2. Contact's Position in Organization: Chief Financial Officer
3. Federal Identification Number 56- 6000324
4. Kind of Organization: Corporation Trust Partnership Government X
Unincorporated Association Other
5. Match Required (Circle One): Yes On a to basis.
If matching is required, is cash match in hand? Yes No
If the required match is not in hand, by what date and from what source does the organization expect to have the cash
match?
6. Fiscal Year of Non -State Entity (e.g. year ending June 30, December 31, other) June 30
Part B. TO BE COMPLETED BY ALL NON - GOVERNMENTAL RECIPIENTS
1. Please enclose the following:
a. Articles of Incorporation and by -laws, trust indenture, partnership agreement, etc.
b. List of Board of Directors/Trustees.
c. Policy addressing conflicts of interest.
d. Sworn Statement of no overdue tax debts.
Part C. TO BE COMPLETED BY ALL RECIPIENTS. FORM MUST BE NOTARIZED '
Signature of individual making
Lisa Wurtzbacher, Chief Financial
, A1Aj=AA72%L5Cq
Notary Public (official seal)
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