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Account Name <br />Permits, Fees, <br />lnsurance <br />Facility Rental <br />Equipment Rental <br />Office Supplies <br />Online Advertising <br />Print Advertising <br />Print Materials <br />Speaker & Talent <br />Fees <br />Signage <br />Expense Totals <br />Profit & Loss <br />Past Actual 3 <br />$ o.oo <br />$ o.oo <br />$ o.oo <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ o.oo <br />$ o.oo <br />$ o.oo <br />Past Actual 3 <br />$ 0.00 <br />Past Actual 3 <br />$ 0.00 <br />Past Actual 2 <br />$ 0.00 <br />$ o.oo <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ o.oo <br />$ 0.00 <br />Past Actual 2 <br />$ 0.00 <br />Past Actual 2 <br />$ o.oo <br />Past Actual 1 <br />$ 0.00 <br />$ o.oo <br />$ 0.00 <br />$ 0.00 <br />$ o.oo <br />$ o.oo <br />$ 0.00 <br />$ o.oo <br />$ o.oo <br />Past Actual 'l <br />$ o.oo <br />Past Actual 1 <br />$ o.oo <br />Projected <br />$ 1000.00 <br />$ 1500.00 <br />$ 4200.00 <br />$ 100.00 <br />$ 200.00 <br />$ 1000.00 <br />$ 500.00 <br />$ 3500.00 <br />$ 200.00 <br />Projected <br />$ 16250.00 <br />Projected <br />$ 25004.76 <br />Application Certif ication <br />The applicant here certifies and affirms: 1. That it does not no4 nor will it during the performance of any contract arising <br />from this application, unlawfully drscriminate against any employee, applicant for employment, client, customer, or other <br />person who might benefit from said contract, by reason of age, race, color, ethnicity, sex, religion, military status, sexual <br />orientation, creed, place of birth, or disability; 2. That it will abide by all relevant local, state and federal lar,rn and <br />regulations and; 3. That it has read the information conlained in the lnstructions on pages 1 and2 and understands and <br />will comply with all provisions thereof. <br />Certified by: <br />Name* <br />Applicant's Title* <br />Maria Adams <br />Roslyn Cemetery Kiosk Dedication <br />Ceremony Chair <br />Sign