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9129122, 10:47 AM <br />Profit & Loss <br />Past Actual 3 <br />$ 261.00 <br />Past Actual 2 <br />$ -511.00 <br />LTAC Clerk Review <br />Past Actual 1 <br />$ 28946.00 <br />Projected <br />$ 204838.84 <br />Application Certification <br />The applicant here certifies and affirms: 1. That it does not now, nor will it during the performance of any contract <br />arising from this application, unlawfully discriminate against any employee, applicant for employment, client, customer, <br />or other person who might benefit from said contract, by reason of age, race, color, ethnicity, sex, religion, military <br />status, sexual orientation, creed, place of birth, or disability; 2. That it will abide by all relevant local, state and federal <br />laws and regulations and; 3. That it has read the information contained in the lnstructions on pages 1 and 2 and <br />understands and will comply with all provisions thereof. <br />Certified by <br />Name* <br />Sign <br />Jessica Solberg Black <br />Applicant'sTitle* ExecutiveDirector <br />lf-app-16-03.co.kiftitas.wa.us/Forms/form/submission/history/77087/85583?hideHeader=true 19/19