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3. List any additional expenses the municipality may incur in order to implement the 2018 Recycling <br />Performance Work Plan: <br />RECYCLING BUDGET <br />4. Attach a copy of your 2018 municipal budget for ALL recycling activities, including ALL funding sources. If <br />your governing body has not adopted the 2018 budget, attach the most current draft. If the budget does not <br />list ALL expenditures and revenues specific to recycling add a supplemental table to identify this information <br />A final copy of the adopted 2018 budget must be submitted by January 15, 2018. <br />PUBLIC ENTITIES LAW COMPLIANCE <br />5. Attach a copy of the disclosure from your hauler(s) OR a copy of the relevant portion of any contracts with <br />haulers that specifies the facility where collected waste is deposited. A hauler's generic waste disclosure <br />form that lists multiple facilities where waste may be delivered is NOT acceptable. <br />RESOLUTION <br />6. Attach a resolution from your governing body requesting the 2018 SCORE funding allocation OR a certified <br />copy of the official proceedings at which the request was approved. 2018 SCORE grant agreements cannot <br />be issued without this attachment. <br />Kerrie Kane <br />NAME OF PERSON AUTHORIZED TO SUBMIT GRANT <br />Kerrie Kane <br />SIGNATURE (electronic signature is acceptable) <br />Receptionist/Recycling Coordinator <br />TITLE <br />October 18, 2017 <br />DATE <br />Return the completed grant application and attachments to Terese Bordeau via email or snail mail by: <br />4:30 p.m. on OCTOBER 31, 2017, <br />SCORE Program <br />Saint Paul — Ramsey County Public Health <br />Environmental Health Division <br />2785 White Bear Avenue N., Suite 350 <br />Maplewood, MN 55109-1320 <br />to rese. b o rd ea u (cDco. ra m sey. m n. us <br />Page 2 of 3 <br />