Cultural Council Agenda and Packet 2012 02 29

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Boulder 21. A representative from my organization attended a 2012 SCFD grant workshop. 22. ASSURANCES - Verify that the authorizing official has read the assurances below by checking: The applicant certifies that all information in this application, including attachments and supporting materials, is true and Daccurate to the best of their knowledge. This application is considered public record and thus is subject to an open records request. The applicant assures that it has a Board approved nondiscrimination statement in compliance with the SCFD statement. Elbases the following: The applicant pledges not to discriminate against any employee, volunteer or program participant on the bases of age, race, sex, color, creed, religion, national origin, sexual orientation, transgender status, gender identity, gender expression, ancestry, marital status, gender, military, veteran status, political service, affiliation or disability. The applicant assures that its registration with the Colorado Secretary of State's Charitable Solicitations Act (CCSA) is current or that the organization is exempt from registering. The applicant states that there have been no changes to the organization's mission statement, Articles of Incorporation, bylaws, nondiscrimination statement or IRS tax exemption status (including expiration of the advance ruling period) since the information was furnished to the SCFD. OR There have been changes to the applicant's: ❑ Mission Statement ❑ Articles of Incorporation ❑ Bylaws ❑ Nondiscrimination Statement IRS tax exemption status (including expiration of the advance ruling period) since the information was furnished to the ❑ SCFD. ❑The applicant will immediately notify the County Cultural Council(s) and SCFD District office of any significant financial, programmatic or budgetary changes from those stated in the grant. nThe applicant will notify SCFD staff of any staff /contact changes. scfd @scfd.org ❑The applicant agrees to display the SCFD logo on all promotional materials (including websites) and to verbally acknowledge the SCFD & County Cultural Council (as appropriate) at programs, activities or events. The applicant agrees to comply with the SCFD funds reporting and fiscal /performance review requirements. nAll Final Grant Reports must be submitted by February 15, 2014. For funds received between October 2011 - September 2012, a Final Grant Report is due February 15, 2013. nThe applicant certifies that all Final Grant Reports have been filed for all grants awarded in previous years. Authorizing Official Signature - Please sign after printing (Paper copies must have an original signature.) Authorizing Person Title ❑ The organization's Board Chair and /or Executive Director has reviewed this application prior to submittal. Date Page 8 of 10