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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 County <br /> ❑ Governmental/public agency <br /> ❑Tribe <br /> Federal Tax ID (EIN) <br /> Unified Business Identifier <br /> (UBI) <br /> Total Funding Request <br /> Brief Project Description (50 <br /> words or less) <br /> Applicant Eligibility <br /> FIYES❑NO - Is your agency operating in/providing services in Kittitas County? <br /> LLYES❑NO - Is your agency in good standing with Washington State and Kittitas County? <br /> LLYES❑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 /> Fiscal contact name <br /> Fiscal contact title <br /> Fiscal contact email <br /> Fiscal contact phone <br /> Authorized signatory name <br /> Signatory title <br /> Signatory email <br /> Page111 <br />