2008-009-RES Approving an application for funding through the Texas Department of Housing and Community Affairs for a 2008 Homebuyer assistance program grantRESOLUTION N0. 2008-009
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS,
TEXAS, APPROVING AN APPLICATION FOR FUNDING THROUGH THE
TEXAS DEPARTMENT OF HOUSING AND COMMUNITY AFFAIRS FOR
A 2008 HOMEBUYER ASSISTANCE PROGRAM GRANT,
HOME/AMERICAN DREAM DOWNPAYMENT INITIATIVE (ADDI)
AWARD; DESIGNATING THE AMOUNT OF MATCHING FUNDS AND
CASH RESERVES; AUTHORIZING THE EXECUTION OF ANY AND ALL
DOCUMENTS NECESSARY FOR ACCEPTANCE AND
IMPLEMENTATION OF SAID GRANT UPON NOTICE THEREOF;
MAKING OTHER FINDINGS AND PROVISIONS RELATED TO THE
SUBJECT; AND PROVIDING AN EFFECTIVE DATE.
WHEREAS, the City Council of the City of Paris desires to develop a viable urban
community, including decent housing and a suitable living environment arid expanding economic
opportunities, specifically to provide homebuyer assistance for low and moderate income families
who desire to purchase a home and live within the city limits and ETJ of Paris; and,
WHEREAS, the City Council of the City of Paris is desirous of processing an application
to the Texas Department of Housing and Community Affairs ("TDHCA") for a Homebuyer
Assistance Program/American Dream Downpayment Initiative (HOME/ADDI) Program Grant in
the amount of $200,000.00 to be provided by grant and $14,000.00 to be provided by the City in the
form of property donations and in-kind services; and,
WHEREAS, it is in the best interests of the City of Paris to apply for funding under the
Texas Department of Housing and Community Affairs, HOME/American Dream Downpayment
Initiative (ADDI) Program; and,
WHEREAS, the City Council desires to authorize the Mayor, City Manager, Director of
Community Development, and other appropriate City staff to accept and implement said grant (if
same is received) without further action of City Council;
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF PARIS, TEXAS:
Section 1. That the findings set out in the preamble to this resolution are hereby in all things
approved.
Section 2. That the filing of an application to the Texas Department of Housing and
Community Affairs ("TDHCA") be, and the same is hereby, approved, for a Homebuyer Assistance
Program/American Dream Downpayment Initiative Program (HOME/ADDI) Grant in the amount
of $200,000.00, with $14,000.00 in funds to be provided by the City of Paris from non-federal
resources, including waived fees and the value of city lots donated to the program, to support the
efforts of the City to assist 20 low and moderate income families through the provision of
downpayment and closing cost assistance.
Section 3. That the City Council does hereby approve the HOME Investment Partnership
Program, American Dream Downpayment Initiative, 2008 Program Design, as amended, for
inclusion in the grant application to TDHCA for their approval and acceptance and to serve as the
basis for the Program if said Program is funded by TDHCA.
Section 4. That the City of Paris does hereby agree to specify and utilize funds from the
City's accounts in the amount of $50,000.00 to provide a Cash Reserve designated for the proposed
TDHCA award, with these funds being used to pay program costs before receiving reimbursements
from the State of Texas HOME/ADDI Program.
Section 5. That, should the amount of the grant award from TDHCA be for less than
$200,000.00, the Cash Reserve and Match fund amounts designated for the proposed TDHCA award
shall be reduced proportionate to the amount of the TDHCA award.
Section 6. That the City of Paris does hereby agree to comply with all assurances in
connection with the application and, if funded, the award.
Section 7. That the City Manager be, and he is hereby, appointed as the Authorized Official
of said proj ect and is authorized and directed to execute, on behalf of the City of Paris, an application
for said grant.
Section 8. That the Director of Community Development be, and she is hereby, appointed
as Project Director and is hereby authorized and directed to execute and deliver, on behalf of the City
of Paris, all reports, communications, assurances, and documents necessary for the completion of
said project.
Section 9. That the Director of Finance be, and he is hereby, authorized and directed to serve
as the Financial Officer for said project and to receive and distribute funds for improvements to
sidewalks and other amenities in the Downtown area.
Section 10. That the Mayor, City Manager, Director of Community Development, and the
Finance Director be authorized and directed to execute, on behalf of the City of Paris, any and all
documents necessary for acceptance and implementation of said grant upon notice of award thereof
by the Texas Department of Housing and Community Affairs, under the terms and conditions and
in the forms approved by the City Attorney, and to proceed with use of said funds upon receipt
thereof for the purposes stated herein and in accordance with the grant conditions.
Section 11. That this resolution shall be effective from and after its date of passage.
PASSED AND APPROVED this 28th day of January, 2008.
/r
J se James reelen, Mayor
ATTEST:
.
ice Ellis, City er
APPROVED AS TO FORM:
L..~~
W. Kent c ya Ci y Attorney
PART III
Attachment II
Uniform Housing Programs
Application
EXHIBITg.
UNIFORM HOUSING PROGRAMS APPLICATION FOR
SINGLE FAMILY ACTIVITIES
Texas Department of Housing and Community Affairs (TDHCA)
Mailing Address: P.O. Box 13941, Austin, Texas 78711-3941
Physical Address: 221 E. 11 th Street, Austin, TX 78701
TABLE OF CONTENTS
1. APPLICANT INFORMATION ............................................................................................................................................3
A. APPLICANT CONTACT INFORMATION 3
B. APPLICANT LEGAL DESCRIPTION .............................................................................................................................3
C. APPLICANT DISCLOSURES 3
D. APPLICATION TECHNICAL ASSISTANCE AND CAPACITY BUILDING .....................................................................4
E. CONSULTANT OR ADMINISTERING AGENT .............................................................................................................4
2. LOCATION & JURISDICTION INFORMATION of the APPLICATION ACTIVITY ...........................................................4
3. FUNDING REQUEST .........................................................................................................................................................5
A. PROGRAM FUNDS .......................................................................................................................................................5
B. PROGRAM ELIGIBLE ACTIVITIES ...............................................................................................................................5
C. FUNDING REQUEST ....................................................................................................................................................5
D. PREVIOUSLY AWARDED STATE AND FEDERAL FUNDING 5
4. POPULATIONS SERVED ..................................................................................................................................................6
A. PROPOSED LOW INCOME LEVELS TO BE SERVED 6
B. RELOCATION ...............................................................................................................................................................6
C. SPECIAL NEEDS & PERSONS WITH DISABILITIES ...................................................................................................6
PART A. CERTIFICATION OF APPLICANT 7
PART B. PREVIOUS PARTICIPATION AND BACKGROUND CERTIFICATION FORM (ALSO REFERRED TO AS THE °PREVIOUS
PARTICIPATION CERTIFICATION IN THE HTC QAP) ................................................................................................................9
PART C. EVIDENCE OF NONPROFIT ORGANIZATION ............................................................................................................13
Attachment 1, Page 2 of 15
'E_0F
x
UNIFORM HOUSING PROGRAMS APPLICATION
FOR SINGLE FAMILY ACTIVITIES
Texas Department of Housing and Community Affairs (TDHCA)
Mailing Address: P.O. Box 13941, Austin, Texas 78711-3941
Physical Address: 221 E. 11"h Street, Austin, TX 78701
Special Notation Symbols Used in the Application:
~ Attachment may be required. X Section does not apply to all Applicants ~ Significant Issue
The undersigned hereby makes application to TDHCA for financial assistance, has read and understands the application instructions,
and certifies that all information herein is true and correct to the best of their knowledge and belief.
! Submitted Application must have the original signature from a representative with authority to execute documents on the
ApplicanYs behalf.
Kevin Carruth
ApplicanYs Authorized Representative's Signature Representative's Printed Name, Tifle Date
1: APPU+CAN't tNMOMAMPI
Provide the contact data for the ApplicanYs staff person who is responsible for application and contract administration. This contact will
not be the consultant or the end seivice provider.
A. APPLICANT CONTACT INFORMATION
Applicant Legal Name: City of Paris Phone: (903) 784-9202
Applicant Contact Name: Kevin Carruth Fax: (903) 785-8519
Applicant Mailing Address: P. 0. Box 9037
City, State, ZIP: Paris, Texas 75461-9037 Email: kcarruth@paristexas.gov
If Applicant's "Physical Address" is different from the "Mailing Address," provide the physical address below.,
Applicant Physical Address: 13515t Street S.E.
City, State, ZIP: Paris, Texas 75460
B. APPLICANT LEGAL DESCRIPTION
Applicant is legally formed? ❑ No 0 Yes If yes the Federal Taxpayer ldentification #(TIN) is: 75-6000635
Legal Form of Applicant (check only one):
❑ For-profit Corporation ❑ Non-profit Corporation ❑ General Partnership ❑ Limited Partnership
❑ Limited Liability Company 0 Unit of Local Government ❑ Individual/D.B.A. ❑ Housing Authority
Other Designations (Mark all that apply.): ❑ Historically Underutilized Business ❑ CHDO ❑ COG M Federal Tax Exemption
Applicant is in good standing with the Secretary of State? ❑ No M Yes The State Filing # is:
ApplicanYs Fiscal Year Ends: Month September Day: 30
C. APPLICANT DISCLOSURES
It If "Yes" is answered for any of items 1 " through "5" below, please provide a thorough explanation of the circumstances and
copies of correspondence regarding the status of ruling from the authority that made the determination, and place behind Tab 1.
Has the Applicant:
1) been delinquent on filing of any federal or state tax returns? Z No ❑ Yes
2) received federal or state findings? Z No R Yes
3) been delinquent on federal or state debt? Z No ❑ Yes
4) been debarred from HUD' or other federal programs? Z No El Yes
5) filed bankruptcy in the last 10 years? Z No ❑ Yes
I It is the responsibility of the Applicant to contact HUD to ensure they have not been disbarred, as HUD does not always notify
persons that they have been disbarred.
Attachment 1, Page 3 of 15
D. APPLICATION TECHNICAL ASSISTANCE AND CAPACITY BUILDING
Has the Applicant received technical assistance or capacity building training for their organization for completing this application or for the
Activity for which this application is being made? E No ❑ Yes
If "Yes", it was sponsored by: ❑ TDHCA ❑ Other (Sponsor Name):
The Activity was: ❑ Workshop ❑ Field Office Assistance ❑ Capacity Building Funds ❑ Predevelopment Funds
❑ Other (describe Activity):
E. CONSULTANT OR ADMINISTERING AGENT
X If a Consultant or Administering Agent was used to complete the application, then provide the following informa6on:
Consultant Name: Hunter & Hunter Consultants, Inc. Phone: (972) 771-5907
Contact Name: Michael Hunter Fax: (972) 722-3966
Mailing Address: 220 W. Quail Run Road Email: michael@hunter-
hunter.co
City, State, ZIP: Rockwall, Texas 75087 Proposed Fee:
TaxpayerlD # (TIN): 75-2640011
m
$0
Does the ConsultantlAdministering Agent qualify as a HUB? Z No Fl Yes
Is there a direct or indirect, financial, guarantor or other interest with Applicant or other team members? Z No ❑ Yes
If "Yes," describe relationship(
2. 'LOCATtflN & JURISDICtIQN tNFORMATIC1N! of tto APPL1CATt4N ACTIVITY'
Local Jurisdiction Name: City of Paris TDHCA Uniform State Service Region: 4
Local Official with Jurisdiction over the Activity site is the: Z Mayor ❑ County Judge R Other:
Local Official Name: Jesse James Freelen Phone: (903) 784-9202
Mailing Address: P. 0. Box 9037t Fax: (903) 785-8519
City, State, ZIP: Paris, Texas 75461-9037
State Senator: Kevin Eltife District
State Representative:
U.S. Representative:
Mark Homer
District 3
Ralph M. Hall District 4
B Attachment may be required. Attach additional jurisdiction information to behind this page.
List the County or
Counties in which the
Check the box below which best describes the area within the county that will be served.
award will be used
Make additional co ies of this form as re uired for additional counties.
1 Lamar
❑ Rural Areas of the County, or
E Urban Areas of the County
List Specific City(ies) or Colonia(s) that will be served: Paris
2
❑ Rural Areas of the County, or
❑ Urban Areas of the County
List S ecific Cit ies or Colonia s that will be served:
3
❑ Rural Areas of the County, or
❑ Urban Areas of the County
List S ecific Ci ies or Colonia s that will be served:
4
❑ Rural Areas of the County, or
❑ Urban Areas of the County
List S ecific Cit ies or Colonia s that will be served:
Attachment 1, Page 4 of 15
3. FUNf•#1NG REt,~UEST
A. PROGRAM FUNDS
Next to the oroaram name. check the box to indicate under which tvqe of funds this application will be made.
General
Contract For
CHDO
Disaster
TDHCA funds for which this Application will be used:
peed
Relief
HOME
El
1:1
Housin Trust Fund HTF
-777
!
B. PROGRAM ELIGIBLE ACTIVITIES
Check the boxes next to the program name to indicate the activities this application will fund.
C_ FUNDING REQUEST
Requested Funds
If the award will be in the
are in the form of a:
f0rm of a loan, the
Com lete the table below to describe this a lication's fundin re uest.
r uested terms are:
TDHCA Programs for which this Application will be
~ o
0~
~
€
used:
R uested Amount
Grant
Loan
d
~
~
HOME Project Funds
$ 200,000
'E~/ 11
❑
HOME Administration Funds (4% of Project FundS
$ 8,000
N
❑
Housing Trust Fund
$
❑
❑
D. PREVIOUSLY AWARDED STATE AND FEDERAL FUNDING
Has this Applicant previously received TDHCA funds? ❑ No Z Yes
Has this Applicant previously received non-TDHCA federal funding? Z No 0 Yes
Will this Applicant receive non-TDHCA federal funding for costs described in this application? Z No ❑ Yes
[M If the answer to any of the above questions is "Yes," then include a funding description behind Tab 1 that at a minimum includes
the source, amount, term and any associated rental restrictions. If the award was from TDHCA, then the TDHCA contract number
should also be provided.
Attachment 1, Page 5 of 15
4. Pt)PUlAT14NS SERVED
! Unless modified by TDHCA, the unit, income, and rent levels to be served as represented by the Applicant in this section shall be a
condition of the funding award. If applicable, appropriate restrictions shall be incorporated into the funding contract/commitment and
land use restriction agreement.
A. PROPOSED LOW INCOME LEVELS TO BE SERVED
Enter the proposed number of Low Income Households to be
served at each Maximum Allowable Household Income Level.
INCOME LEVEL OF PROPOSED
;
HOUSEHOLDS
=ar
30% AMFI'
> 30% and 50% AMFI
> 50% and 60% AMFI
> 60% and 80% AMFI
20
Total assisted units b ro ram
Notes:
(1) TDHCA is committed to targeting funds towards households
earning less than 30 percent of the area median family income.
Applicants are encouraged to income target households that
earn 30% or less of the AMFI in an effort meet the DepartmenYs
obligation.
B. RELOCATION
Is temporary relocation of a current tenant(s) anticipated during
the rehabilitation period? Z No El Yes
Is permanent relocation of a current tenant(s) anticipated during
or after the rehabilitation period? Z No ❑ Yes
R If the answer to either of the previous two questions is
"Yes," then a relocation plan must be provided behind Tab 1.
C. SPECIAL NEEDS & PERSONS WITH DISABILITIES
x Only Applicants proposing to serve Special Needs
populafions must complete this section.
TDHCA has a goal of allocating 20 percent of the annual HOME
allocation to Applicants serving persons with special needs.
Eligible activities include owner occupied housing assistance,
homebuyer assistance, and tenant based rental assistance.
Unless approval by the Department is granted, this applica6on
will serve only persons that qualify under the following HUD
special needs or persons with disabilities designations. If
applicable, please indicate the number of households proposed
to serve:
persons with dru and alcohol addictions
colonia residents
persons with disabilities
victims of domestic violence
elderl persons
persons with HIV/AIDs
homeless ulations
mi rant farm workers
An Applicant may serve 100% Special Needs populations, or a
percentage of Special Needs populations. The proposed numbers
must be indicated above.
Attachment 1, Page 6 of 15
; EXHIBiT 1. F14RTiCIPAW'Pt 44 Nt A000d"AWN 1NFORMATI4N
Part A. Certification of Applicant
This certificafion musf be signed and filed by persons who are authorized to execute fhe HOME contracf.
I hereby apply to the Texas Department of Housing and Community Affairs for approval to participate in this Application
Activiiy as the Applicant. 1 certify that all statements made by me in the "Participants in fhe Applicafion Information" section
of the Application and related exhibits are true, complete, and correct and are made in good faifh. I further certify that:
(1) The Participants in the Application Information, Previous Participation Certification, herein after referred to as the
"Previous Participation Certification" contains a listing of every development activity that received TDHCA funding,
which I have been or am now an Applicant.
(2) For the period beginning ten years prior to the date of this certification:
(a) I have not been arrested, indicted, convicted, or imprisoned for a felony dunng the last ten years, and am not
presently the subject of a complaint or indictment charging for a crime of moral turpitude.
(b) I have not been suspended, debarred, or been subject to enforcement action under state or federal securities law,
or otherwise restricted by any department or agency of federal or state govemment from doing business with
such department or agency.
(c) I have not defaulted on an obligation covered by a surety or performance bond and have not been the subject of
a claim untler an employee fidelity bond.
(3) For the period beginning ten years prior to the date of this certification, during my participation in the developments
shown by me in the Previous Participation Certification, there has not been:
(a) a mortgage in tlefault, assigned or foreclosed, nor has mortgage relief by the lender been given;
(b) to the best of my knowledge, unresolved findings raised as a result of Departmental or HUD audits, management
reviews or other governmental investigation conceming me or my developments, or contracts;
(c) any breach by the owner of any agreements relating to the construction or rehabilitation, use, operation,
management, or disposition; or
(d) a suspension or termination of payments under any state or federal assistance contract.
(4) To the best of my knowledge, the Applicant has demonstrated fiscal, programmatic, and contractual compliance on
previously awarded Department contracts or loan agreements and resolution of any previous audit findings and
outstanding monetary obligation with the Department per 10 TAC Section 53052 (c) (2) and (3).
(5) As required by Section 2306.257 of the Texas Govemment Code, as added by SB 322, 77th Session of the Texas
Legislature, an Applicant may not receive funds or other assistance from the Department unless the Applicant certifies
that it is in compliance with the housing laws described in subparagraph (a) through (d) of this paragraph. To satisfy
that requirement, I hereby certify that the developments listed in the Previous Participation Certification, in which I am
currently participating, are in compliance with:
(a) state and federal fair housing laws, including Chapter 301, Property Code, the Texas Fair Housing Act; Title IV of the
Civil Rights Act of 1968 (42 U.S.C. Section 3601 et seq.); and the Fair Housing Amendments of 1988 (42 U.S.C.
Section 3601 et seq.),
(b) the Civil Rights Act of 1964 (42 U.S.C. Section 2000a et seq.),
(c) the Amencans with Disabilities Act of 1990 (42 U.S.C.12101 et seq.), and
(d) the Rehabilitation Act of 1973 (29 U.S.C. Section 701 et seq.).
(6) The Applicant also certifies that the Applicant, or a branch, division, or department of said Applicant does not and will
not knowingly employ an undocumented worker, where "undocumented worker" means an individual who, at the time
of employment, is not lawfully admitted for permanent residence to the United States or authorized under law to be
employed in that manner in the United States. If, after receiving a public subsidy, the Applicant, or a branch, division,
Attachment 1, Page 7 of 15
or department of the Applicant is convicted of a violation under 8 U.S.C Section 1324a(fl, the Applicant shall repay the
amount of the public subsidy with interest, at the rate and according to the other terms provided by an agreement
under Tex. Gov't Code Section 2264.053, not later than the 120th day after the date TDHCA notifies the Applicant of
the violation."
Once staff recommends that an Applicant receive an award and before the award is granted by the Board, the
Department and the Applicant must enter into an agreement that says, at least:
"The Applicant agrees that if the Applicant, or a branch, division, or department of the Applicant is convicted of a
violation under 8 U.S.C Section 1324a(fl, the Applicant shall repay the amount of the public subsidy with interest, at
the rate of (TBD) % per annum, not later than the 120th day after the date TDHCA notifies the Applicant of the
violation."
(7) I further certify that I understand that the Department periodically monitors for compliance with the requirements
specified in paragraph (5) during the construction phase of a housing development that has received funds or other
assistance from the Department. The monitoring level for each housing development is based on the amount of risk of
noncompliance with the requirements specified in paragraph (5) associated with the development. The Department
shall notify a recipient who has received funds or other assistance from the Department in writing of an apparent
violation and shall afford the recipient a reasonable amount of time, as determined by the Department, to correct the
identified violation, if possible, prior to the imposition of a sanction. The Department shall notify the Texas Commission
on Human Rights at the same time notification is sent to the recipient. I understand that the Department may impose
one or more of the following sanctions depending on the severity of the violation of a law specified in subsection (5) by
a recipient of housing funds or other assistance from the Department:
(a) a reprimand posted on the Department's website,
(b) termination of assistance, or
(c) a bar on future eligibility for assistance through a housing program administered by the Department. A bar shall
be in place for at least one calendar year from the date of imposition by the Department and may not last for more
than ten calendar years from the date of imposition.
Applicant's Signature: Date:
Applicant Printed Name: Kevin Carruth
ApplicanYs Title:Citv Manaqer
List the "Applicant Legal Name" followed by the "Program Code" for each current or pending TDHCA application in which
this entity is an Applicant. Use the following program codes: HOME Program = HM, Housing Trust Fund = HT, Housing
Tax Credit = HTC, Office of Colonia lnitiatives = OC, Tax-exempt Private Activity Mortgage Revenue Bond = TP, 501 (c)(3)
Tax-exempt Mortgage Revenue Bond = TM: Citv of Paris Texas HM
Attachment 1, Page 8 of 15
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EKWtOff 7. PARTtClf'AN"t$ IN THE APPUCATlOFI INFORMATI4N
PART B. PREVIOUS PARTICIPATION AND BACKGROUND CERTIFICATION FORM
SECTION 3. NATIONAL PREVIOUS PARTICIPATION AND BACKGROUND CERTIFICATION FORM
SubseCtion (a). Applicant's Authorization to Release Request for Compliance Status (To be completed by Applicant.)
The Applicant named below is applying for funding from the Texas Department of Housing and Community Affairs (TDHCA) for the
following developments (List the "Applicant Legal Name" for each current or pending TDHCA application of the Applicant): Citv of
Paris. Texas
The under signed, hereby requests and authorizes the agency named in Subsection (b) to release to TDHCA information regarding
any low-income housing development that the agency monitors and in which this Applicant has or is participating. A description of the
ApplicanYs participation in this state's affordable housing programs is provided in Subsection (c).
ApplicanYs Signature
Date
Kevin Carruth
ApplicanYs Printed Name
SubseCfion (b). State aqency Response to Request for Compliance Stahus (To be completed by State Agency.)
The information disclosed on this form will be taken into consideration by TDHCA when making funding decisions for the 2005
calendar year.
State Agency Name:
Address:
City:
Contact:
State: ZIP: Phone:
1. Has this state agency issued an 8823 for any violations in the last three years in the following categories?
❑ Major violations of health, safety, and building codes. Such finding is ❑ Corrected ❑ Uncorrected
❑ Refusal to lease to persons with Section 8 vouchers. Such finding is ❑ Corrected ❑ Uncorrected
❑ Determination of a violation under the Fair Housing Act. Such finding is ❑ Corrected ❑ Uncorrected
❑ Development is out of compliance and is never expected to comply as reported to the IRS via an 8823.
2. Are all the developments under control or ownership by the Applicant named above in compliance? ❑ Yes ❑ No
If "No," what formal or informal action has been taken by your agency?,
Is there other information you wish to share regarding compliance status?.
This response represents this agency's evaluation of the ApplicanYs compliance status as of February 28, 2005.
Prepared By:
Title / Phone Number
Date
Please return "Exhibit 1, Part E, Section 3" to TDHCA within 30 days of receipt. This documentation can be transmitted by mail to:
TDHCA Compliance Monitoring Division, P.O. Box 13941, Austin, Texas 78711-3941, or via fax at 512.475.3359. If you have any
questions, contact Jo En Taylor at (512) 475-4972. Your prompt response and any information that you are able to share is greatly
appreciated.
Part II, Page 11 of 15
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EXHIBtT 1. PARTICIPAh1'1'S IN THE A1'PLtCAT1ON INFaRMATIQN
Part C. Evidence Of Nonprofit Organization
x Only nonprofit organizations will complete this section.
SECTION 'I.ORGANIZATION CERTIFICATION
Organization Name:
Legal Status: ❑ 501(c)(3) ❑ 501(c)(4) ❑ tax-exempt under 501(a) ❑ PHA ❑ other (specify)
Date of legal formation of Nonprofit Organization:
a) Is the Applicant comprised of a joint venture between a Nonprofit Organization and for-profit entity?
❑ Yes ❑ No. If "Yes", will this nonprofit organization Contro18 the Applicant? ❑ Yes ❑ No.
What is the ownership percentage of this nonprofit organization?
b) Describe the nonprofiYs participation in the development:
c) Describe the nonprofiYs participation in the operation of the development throughout the compliance and/or extended use period:
d) Does the nonprofit have prior experience in owning, managing or developing affordable housing?
❑ Yes ❑ No. If "Yes", describe such experience:
e) If the nonprofit will participate through a related subsidiary entity, provide the name of such entity:
Subsidiary Entity Name:
Legal Status: ❑ 501(c)(3) ❑ 501(c)(4) ❑ tax-exempt under 501(a) ❑ PHA El Other (specify)
fl Is the nonprofit (or related subsidiary entity) assured of owning an interest in the development throughout the compliance period?
❑ Yes ❑ No
g) Will the nonprofit be contributing funds to the development? ❑ Yes ❑ No If "Yes", explain:
h) Will the nonprofit receive any part of the development or management fees paid in connection with the development? ❑ Yes ❑
No If "Yes", explain:
8 Control - the possession, directly or indirectly, of the power to direcf or cause fhe direction of the managemenf and policies of any
Person, whether through the ownership of voting securities, by contract or otherwise, including specifically ownership of more than
50% of the general pa►tner inferest in a limited partnership, or designafion as a managing general partner or the managing member of
a limited liability company.
Part II, Page 13 of 15
i)
How many full time staff members does the nonprofit have?
proposed development? Describe their activities:
j) Has any for-profit entity (including the owner of the development or any entity directly or indirectly related to such owner)
appointed any directors to the governing board of the nonprofit? ❑ Yes Fl No
If "Yes", explain:
k) Does the nonprofit have any financial arrangements with an individual(s) or for-profit entity including anyone or any entity related
directly or indirectly to the owner of the development? ❑ Yes ❑ No
If "Yes", explain:
1) Disclose any personal (including family) relationships that any of the staff members, directors or other individuals involved in the
formation or operation of the nonprofit have, either directly or indirectiy, with any persons or entities invoived or to be involved in
the development on a for-profit basis including, but not limited to, the owner of the development, any of its for-profit general
partners, employees, limited partners or any other parties directly or indirectly related to such owner:
m) Was this organization formed by any individuals or for profit entities for the Applicant purposes of ineeting set aside requirements
or scoring preferences associated with this application? ❑ Yes ❑ No
Purpose(s) of formation of nonprofit:
n) Do the members of this organization's Board of Directors serve in a voluntary capacity and receive no compensation, other than
reimbursement for expenses for their services, and the nonprofit organization operates in a manner so that no part of its net
earnings inures benefit of any individual, corpora6on, or other entity? ❑ Yes ❑ No
The undersigned Applicant and nonprofit entity hereby each certify that, to the best of its knowiedge, all of the forgoing information is
correct, complete and accurate.9
Applicant/Owner Name Nonprofit Name
By:
Authorized Signature
Name:
Title:
Date:
By:
Authorized Signature
Name:
Title:
Date:
9 If different, bofh the nonprofit organization and the applicant must sign.
How many of them will substantially participate in the
Part II, Page 14 of 15
.
~~1~IT"~,R • A~~~~~"T~~PAl;~~,,,, ~yi T~W0
Part C. Evidence of Nonprofit Organization
SECTION 2. LIST OF THE NONPROFIT ORGANIZATION'S BOARD MEMBERS, DIRECTORS AND OFFICERS
Name: Title:
Home Address:
City:
Occupation:
St.: Zip: Phone: ( ) Ext:
Fax: ( )
Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity?~OE]Yes ❑ No
(2) have a relationship, as Affiliate or otherwise, w/ members of the Applicant or Development Team? Yes ❑ No
Name: Title:
Home Address:
City: St.: Zip: Phone: ( ) Ext:
Occupation: Fax: ( )
Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity? ❑ Yes El No
(2) have a relationship, as Affiliate or othervuise, wl members of the Applicant or Development Team? M Yes ❑ No.
Name: Title:
Home Address:
City: St.: Zip: Phone: ( ) Ext:
Occupation: Fax: ( )
Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity? ❑ Yes ❑ No
(2) have a relationship, as Affiliate or otherwise, w/ members of the Applicant or Development Team? Yes ❑ No
Name:
Home Address:
City:
Occupation:
Ext:
Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity? ❑ Yes ❑ No
(2) have a relationship, as Affiliate or otherwise, w/ members of the Applicant or Development Team? ❑ Yes ❑ No
Name:
Home Address:
City:
Title:
Title:
St.: Zip: Phone:
Ext:
Occupation: Fax: ( )
Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity? El Yes ❑ No
(2) have a relationship, as Affiliate or otherwise, w/ members of the Applicant or Development Team? 0 Yes ❑ No
(Make additional copies of this form as required for additional board members, directors, and officers.)
St.: Zip: Phone:
Fax:
10 An individual is considered to be acting in a private capacity if the individual is not an employee of a public body and
is not being paid by a public body while performing functions in connection wifh the nonprofit organization. A public
body is any state, cify, county, town, township, village or other general purpose political subdivision of the state.
11 If "Yes", attach explanation of such relationship to this form.
Part II, Page 15 of 15