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Page | 12 <br /> <br />1. RFP Summary Form <br />Please complete the following form in its entirety and attach as a PDF to your submission email. <br />Project Title <br />Agency Name <br />Mailing Address <br />Physical Address (if different) <br />Website (if applicable) <br />Agency Type Nonprofit 501(c)(3) <br />Private business entity offering relevant services in Kittitas <br />County <br />Governmental/public agency <br />Tribe <br />Federal Tax ID <br />Unified Business Identifier (UBI) <br />Total Funding Request <br />Brief Project Description (50 <br />words or less) <br /> <br /> <br />Applicant Eligibility <br />YES/NO - Is your agency operating in/providing services in Kittitas County? <br />YES/NO - Is your agency in good standing with Washington State and Kittitas County? <br />YES/NO - Has your agency been debarred from operations? <br />Applicant Contact Information <br />Primary project contact name <br />Primary contact title <br />Primary contact email <br />Primary contact phone <br /> <br />Fiscal contact name <br />Fiscal contact title <br />Fiscal contact email <br />Fiscal contact phone <br /> <br />Authorized signatory name <br />Signatory title <br />Signatory email <br />Signatory phone