Community Resource Center
2016 PARTNERSHIP APPLICATION
Agency Name:
______
Mailing Address: ______
City: ______County: ______State: ______
Zip: ______
Phone: ______FAX: ______
E-Mail Address: ______
How did you hear about CRC? (If referred by a current partner, please give the agency name)
______
Agency Contacts:
Executive Director ______
The name of the person who will be responsible for receiving correspondence from the Community Resource Center:______
What is your current agency budget: $ ______
How many unduplicated clients did your agency serve last year? ______
Please identify the service area your agency/program covers: (Please only answer one)
City only :
County only :
Middle TN only :
Statewide :
National :
International :
Does your agency provide residential and/or supportive housing services?
❏Yes
❏ No
Please check only one that describes your Agency Type:
❏Arts and Cultural
❏Education and Partner Schools
❏Environmental
❏Faith-based
❏Governmental
❏Healthcare
❏Human Service
❏Legal/Rights/Humane
Annual Partnership Fee $______
Community Resource Center
Contract of Eligibility
Organization Name: ______
Address______
City ______State ______
Zip ______
Phone ______FAX ______
Federal Tax-Exempt Number ______
Executive Director or Contact Person ______
The above named organization,“Agency,” agrees to the following terms and conditions in use of Items donated through the programs of the Community Resource Center:
1. All “Items” received by Agency will be used solely by and for the tax-exempt purposes of the agency. Agency must be now, and in so long as Agency uses Items donated through the Community Resource Center, a tax-exempt, not-for-profit Corporation. Items cannot be used for fundraisers, raffles or auctions; given to staff for personal use; sold in stores, flea markets or anywhere else.
2. Agency shall not destroy, discard, sell or otherwise dispose of the Items. Agency shall make all reasonable efforts to protect Items against damage, theft, and loss. Donations must be used by Agency to operate their own offices or be distributed to clients free of charge.
3. At such time when Items are no longer of use to Agency, or in the event that Agency ceases to exist or operate for tax-exempt, not-for-profit purposes, Items will be given to other tax-exempt, not-for-profit corporations.
4. Neither the donor nor the Community Resource Center make any representation as to the condition of the Items, nor do such parties guarantee or warrant its use. Neither party has an obligation to maintain, repair or replace the Items. It will be the sole responsibility of the Agency to keep the Items in good working order and condition, less ordinary wear and tear.
5. It is understood that neither the Community Resource Center, nor any donor, shall be liable for any claim of injury or damage resulting from, but not limited to the acquisition, use, transport or disposition of the Items.Agency indemnifies and holds blameless the Community Resource Center and all donors, their employees, agents, and servants, against any liability or damage resulting from or in connection to the acquisition, use, transport, or disposition of the Items, including claims for bodily injury to persons or damage to property, whether or not such liability or damage arises or results from negligence, fault or default by Agency, Community Resource Center, any donor, employees, agents or servants, or for any other reason.
6.The organization agrees to maintain adequate books and records of these donations as required by applicable tax regulations and to make such records available upon request to CRC and/or any relevant taxation authority.The organization agrees to provide complete substantiation of its distribution of all product donations to any relevant taxation authority and/ or CRC upon request.
7. Agency will give the Community Resource Center permission to conduct site visits for the purpose of providing evidence of appropriate use of items.
8. Failure by Agency to comply with any of the terms set forth above will result in the termination of this agreement and loss of any fees paid.
Agreed and accepted by:
Name ______Date ______
Title ______Signature ______