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9129122,12:18 PM <br />Memberships $ 500.00 <br />Expense Totals <br />Profit & Loss <br />Certified by: <br />Name* <br />Past Actual 3 <br />$ 89977.51 <br />Past Actual 3 <br />$ -79977.51 <br />CheriMarusa <br />$ 600.00 <br />Past Actual 2 <br />$ 123951.00 <br />Past Actual 2 <br />$ -113021.00 <br />LTAC Clerk Review <br />$ 700 00 <br />Past Actual 1 <br />$ 180450.00 <br />Past Actual 1 <br />$ -163517.50 <br />$ 800.00 <br />Projected <br />$ 203550.00 <br />Projected <br />$ -115798.00 <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 I and2 and <br />understands and will comply with all provisions thereof. <br />Applicant's Title* President <br />lf-app-16-03.co.kittitas.wa.us/Forms/form/submission/history/77354/85652?hideHeader=true 14t14