HomeMy WebLinkAboutEXHIBIT B - Organization Information FormEXHIBIT B
ORGANIZATION INFORMATION FORM
Project Title
Provide the following organizational information in the space provided.
___________________________________________________________________
Organization name as listed on all organizational documents.
Complete name(s) and title(s) of the person(s) authorized to execute agreements on behalf of the applicant.
_________________________________________________________________________________________
Name and contact information of primary representative for proposal application
Organization physical address.
Organization mailing address.
Organization telephone number
Organization website and email addresses
Federal Tax ID Number and Hawai‘I General Excise Tax Number.
Mark which one applies to your organization:
1. Not-for-profit organization incorporated under the laws of the State of Hawaiʻi, or a non- profit organization exempt from the federal income tax by the internal Revenue Service
2. A State, County, research or educational institution or agency
___________________________________________________________________________
Authorized signature
If box number 1 is marked, attach one set of the following required organizational documents.
1. Current Charter or Articles of Incorporation.
2. Current By-Laws.
3. Current Corporate Resolution, if required per by-laws.
4. A current Board of Directors list including names, titles, addresses, occupations, and terms of office for all officers and members of the Board of Directors.
5. Copy of IRS verification of tax-exempt status, if applicable.
6. Current Certificate of Compliance from the State’s Hawai‘i Compliance Express program, government entities excluded.