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Alahou Clean & Sober Clean and Sober Housing Program I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures; and records, reporting and fiscal accountability requirements as mandated in Article 25, Sections 2-135 —2-142.2, Hawaii County Code, relating to Appropriation of Funds to Nonprofit Organizations. I (we) hereby certify that information supplied herein including all supporting documents is correct and that I (we) have the authority and ability to fully administer the program(s) pursuant to law. I (we) understand that information supplied herein shall be made public according to Chapter 92F, Hawaii Revised Statutes. I (we) understand that applications will not be reviewed by County personnel accepting our County Nonprofit Grant submittal, and that we have full responsibility to ensure that all documents are complete and accurate prior to submittal. I (we) understand that all documents requiring a signature must be the ORIGINAL, SIGNED document. Unsigned documents will be disqualified. Faxed or copied documents will not be accepted as original documents. _ If awarded a grant from the County of Hawaii, I (we) understand and will comply with the requirement to submit a year-end report to the County Council within 60 days after June 30 of the fiscal year. The report shall include an explanation of the public benefits derived from the awarding of the grant, a complete accounting of all expenditures supported by County of Hawaii grant funds, and a listing of other funding sources and amounts obtained during the award period. Failure to submit a timely, complete, and accurate year-end report will impact the evaluation of your program's or agency's future funding requests. I (we) understand there is no provision for further notification to submit the final report. No late or incomplete reports will be accepted after the 60 day due date. Information and instructions are available to co.hawaii.us/forms/grantapps.html on or about May 30 of the year the final report is due. Any funds unused by June 30, 2013 must be returned to the County of Hawai'i within 30 days (July 30, 2013). Failure to return these funds in a timely manner will impact the evaluation of your agency's future funding request and may result in actions taken to recover these funds. By signing below, you are acknowledging that you have read and understand these requirements. t/Z 31 2m-2,-- -- Signature of Boar P sident/Chair or Date Agency Director — ( --i Signature of cutive Director Date UNSIGNED PROPOSALS WILL NOT BE ACCEPTED! NONPROFIT GRANT APPLICATION FISCAL YEAR 2012-13 Page 8 of 8