Finance Committee Agenda and Packet 2014 12 15

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CITY OF LOUISVILLE, COLORADO GRANT APPLICATION FOR NON- PROFIT ORGANIZATIONS Please list all funding sources anticipated for the 2015 calendar year for the entire program /agency. Source of Funding Boulder County Government City of Longmont City of Boulder Foothills United Way Arc Thrift Store Distribution Smith Trust Daniels Fund Virginia Hill Foundation Broomfield Community Foundation Collins Trust Investment Income Estimated /Requested $110,000 $5000 $5000 $5000 $598,678 $30,000 $30,000 $5000 $500 $1000 $37,159 Percent of Total 13% .6% .6% .6% 72% 4% 4% .6% .06% .12% 4.42% I swear or affirm that the above information is true and correct to the best of my knowledge and belief. Signature .47AJZA-- Agency Director 303 - 775 -9968 Telephone Number awonnacott@aclboulder.org E -Mail Address Signature Board President 303 - 775 -9968 Telephone Number carsenault @aclbouler.org E -Mail Address Applications may be considered public record after presentation to the Finance Committee pursuant to City Ordinance and the Colorado Open Records Act. The City will notify the applicant of any request for disclosure and it will be the responsibility of the applicant to object and to pursue any legal actions pursuant to Colorado law. An applicant shall notify the City within 24 hours of notification by the City of request for disclosure of the applicant's objections to disclosure and the applicant's intent to pursue lawful protection under Colorado law. Any proprietary or otherwise sensitive information contained in the application is subject to potential disclosure. Submitting it waives any recourse with respect to disclosure and indemnifies the City for any charges directly related to the City's disclosure. 9