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9129122, 12:24 PM <br />Contributions of Volunteer Time <br />Past Actual 3 Past Actual 2 <br />Number of Hours <br />Evidence of Volunteer <br />Contributions* <br />Calculated Value of <br />Projected Volunteer <br />Time <br />Revenue Totals <br />Expenses <br />Operating expenses <br />(insu rance/staff/suppl <br />ies, etc.) <br />Expense Totals <br />Profit & Loss <br />Past Actual 3 <br />$000 <br />Past Actual 3 <br />$000 <br />Past Actual 3 <br />$ 0.00 <br />Past Actual 3 <br />$ 0.00 <br />Past Actual 2 <br />$000 <br />Past Actual 2 <br />$000 <br />Past Actual 2 <br />$ 0.00 <br />Past Actual 2 <br />$ 0.00 <br />LTAC Clerk Review <br />Past Actual 1 <br />100 <br />Past Actual '1 <br />$ 3994.00 <br />Past Actual 1 <br />$ 2800 00 <br />Past Actual 1 <br />$ 2800 00 <br />Past Actual I <br />$ 1194 00 <br />Projected <br />100 <br />Projected <br />$ 14456.00 <br />Projected <br />$ 4500 00 <br />Projected <br />$ 4500.00 <br />Projected <br />$ 9956.00 <br />Please upload a single file which offers evidence in support of the projected volunteer hours <br />Volunteer hours2022 23_Easter.pdf 63.74K8 <br />$ 2,356.00 <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 1 and 2 and <br />understands and will comply with all provisions thereof. <br />Certified by: <br />lf-app-16-03.co.kittitas.wa.us/Forms/form/submission/history/77621186050?hideHeader=true 13t14