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LSTA —Agreement Packet Checklist <br />Use this checklist to prepare your agreement packet for mailing. <br />Required for all grants: <br />❑ Two (2) agreement originals, signed in blue, wet ink. Copied versions are <br />not acceptable. One of these will be mailed back to you after execution. <br />❑ One (1) signed Certification Regarding Debarment and Suspension; <br />Lobbying; Federal Debt Status; And Nondiscrimination. <br />❑ One (1) signed No Overdue Tax Debts Statement, on letterhead. <br />❑ Conflict of Interest Policy — If we attached a policy for your review, and your <br />current policy is different, please include it in your packet. If not, disregard. <br />If we don't have one on file, please include it. <br />Only required if applicable to your ¢rant: <br />❑ One (1) signed CIPA Compliance Certification Form — Read the form <br />information to determine applicability. <br />❑ One (1) LSTA Partner statement, completed by every Partner as indicated <br />in your grant application. <br />❑ One (1) State of North Carolina Substitute W9, to add or update your <br />agency in our accounting system. If you haven't received a grant or State <br />Aid in four or more years, please fill this out and return it with your <br />package. <br />Mailing Instructions on next page. <br />AWachmenl number 6 \n <br />G-7 Page 464 <br />