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Verification of In-kind Contributions <br />Contributions of Volunteer Time <br />Past Actual 3 Past Actual 2 Past Actual 1 Projected <br />Number of Hours <br />Calculated Value of Projected Volunteer Time <br />Total Revenues <br />Past Actual 3 Past Actual 2 Past Actual 1 Projected <br />Expenses <br />Expense Item Past Actual 3 Past Actual 2 Past Actual 1 Projected <br />Expense Totals <br />Profit & Loss <br />Past Actual 3 Past Actual 2 Past Actual 1 Projected <br />The applicant hereby certifies and affirms: <br />1. That it does not now, nor will it during the performance of any contract arising from this application, unlawfully discriminate against <br />any employee, applicant for employment, client, customer, or other person who might benefit from said contract, by reason of age, <br />race, color, ethnicity, sex, religion, military status, sexual orientation, creed, place of birth, or disability; <br />2. That it will abide by all relevant local, state and federal laws and regulations and; <br />3. That it has read the information contained in the Instructions on pages 1 and 2 and understands and will comply with all provisions <br />thereof. <br />Certified by:* <br />Name * <br />KCHS Annual Operating <br />Budget <br />0.00$150000.00$150000.00$150000.00$ <br />In-Kind Contributions <br />For any claimed in-kind contributions valued at $500 or more and related to marketing/advertising, you must submit verifying documentation which assures the contribution will <br />be provided. <br />455 600 0 <br />0.00$ <br />12596.51$170000.00$170000.00$172200.00$ <br />Advertising Expenses 6250.00$20000.00$20000.00$22200.00$ <br />Museum/Tourism Facility <br />Expense <br />6346.51$150000.00$150000.00$150000.00$ <br />12596.51$170000.00$170000.00$172200.00$ <br />0.00$0.00$0.00$0.00$ <br />Application Certification <br />Sadie Thayer