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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 />Applicant's Title * <br />Facility Rentals 2113.14$1350.00$800.00$1300.00$ <br />Equipment Rentals 2395.73$2175.56$1881.54$3500.00$ <br />Operational Expenses 2823.72$3083.10$4119.94$1500.00$ <br />Other expenses not <br />covered by LTAC <br />28046.23$28892.68$31778.68$35000.00$ <br />Capital Projects 27179.51$16689.27$5000.00$130000.00$ <br />Grant Writer 0.00$0.00$0.00$5000.00$ <br />Architect & Engineering 0.00$0.00$0.00$5000.00$ <br />Interpretive Signage <br />Design & Consultant <br />0.00$0.00$17000.00$48200.00$ <br />71325.32$65852.12$77215.97$252600.00$ <br />2893.89$9225.42$6860.45$2620.00$ <br />Application Certification <br />Maria Adams <br />President