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Roman Catholic Church in the State of Hawaii, <br /> Office for Social Ministry <br /> Kihei Pua Emergency Shelter <br /> <br /> I (we) have read and understood all of the eligibility requirements; grant conditions; award <br /> procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, <br /> <br /> Sections 2-1 35 - 2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit <br /> <br /> Organizations. <br /> I (we) hereby certify that information supplied herein including all supporting documents is correct and <br /> <br /> that I (we) have The authority and ability to fully administer the program(s) pursuant to law. <br /> I (we) understand that information supplied herein shall be made public according to Chapter 92F, <br /> Howai'i Revised Statutes. <br /> IF awarded a grant from the County of Hawaii, I (we) understand and will comply with the <br /> requirement to submit ayear-end report to the Legislative auditor within 60 days after June 30 of <br /> the fiscal year. The report shall include an explanation of the public benefits derived from the <br /> awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii <br /> grant funds, and a listing of other funding sources and amounts obtained during the award <br /> period. Failure to submit a timely, complete. and accurate year-end reoori will impact the <br /> evaluation of yourproaram's or agency's future fundina requests. <br /> Signature of Board President~Chair Date <br /> Signature of Executive Director ate <br /> UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! <br /> NONPROFIT GRANT APPLICATION <br /> FISCAL YEAR 20116-07 <br /> Pagc 5 <br /> <br />