2009 FUNDIN
SELF-HELP HOMEOWNERSHIP OP
APPLICATION FO
Housing Assist
1025 Vermont Aven
Washington
Phone: (202) 842-8600
www.rural
HAC is an equal op
2009 FUNDING ROUND
SELF-HELP HOMEOWNERSHIP OPPORTUNITY PROGRAM (SHOP)
APPLICATION FORMS PACKAGE
Housing Assistance Council
1025 Vermont Avenue, NW Suite 606
Washington, DC 20005
Phone: (202) 842-8600 Fax: (202) 347-3441
www.ruralhome.org
HAC is an equal opportunity lender
HOUSING ASSISTANCE COUNCIL
Self-Help Homeownership Opportunity Program (SHOP 2009)
Application Forms
**** IMPORTANT ****
Please read the SHOP FY 2009 Program Description and Application Instructions document in its entirety. Before proceeding, all
applicants must complete the Eligibility Questionnaire (Form 2).
INSTRUCTIONS
1. Each worksheet contained in this workbook is "password-protected." A password is required to unprotect the worksheets. Please
contact HAC at (202) 842-8600, if you experience problems and need the password. The password is case-sensitive. To unprotect the
worksheet, go to Tools, Protection, Unprotect Sheet, then type in the password obtained from HAC.
2. Fill in ALL Yellow boxes, if applicable. Fields in "tan" automatically calculate. Some information may be directly linked to other
spreadsheet cells or worksheets.
3. Amounts fields are automatically set to round to the nearest dollar.
4. Fields with additional comments/instructions are denoted with a red triangle in the upper-right hand corner of the cell. Roll the
cursor over the triangle to reveal the comment.
5. Use the "Page Up/Down" , "Tab" and "Enter" and arrow keys to maneuver through the worksheets. After entering a field of
information, hit "Enter", not the "Tab" key.
APPLICATION DUE DATE
SHOP applications are due in HAC's national office no later than 4:00 p.m. Eastern time on Wednesday, October 7, 2009. Absolutely no
exceptions will be made to this due date. Applications postmarked by October 7, 2009 and received after that date will not be considered.
The address of HAC's national office is:
Housing Assistance Council
Attention: SHOP 2009 Funding Round
1025 Vermont Avenue, NW, Suite 606
Washington, DC 20005
ASSISTANCE NEEDED?
HAC staff is available to address questions on the completion of the SHOP application, as well as respond to technical problems
associated with the application forms. Do not hesitate to contact Brooke Adams (ext. 159) Tanisha Jacob (ext.128), Loan Fund Assistants,
at HAC's National Office at (202)842-8600 or by email at Brooke@ruralhome.org or Tanisha@ruralhome.org.
HOUSING ASSISTANCE COUNCIL
Self-Help Homeownership Opportunity Program (SHOP 2009)
Application Forms
SHOP 2009 FORMS
This workbook contains the following application forms. Clicking on the hyperlink will take you directly to the worksheet or the related
webpage for the required form. Upon opening this file, if you selected "Disable Macros," please exit and re-open again. Select "Enable
Macros" to obtain full functionality of the workbook.
FORM 1: Application Submission Checklist
FORM 2: Eligibility Questionnaire
FORM 3: Applicant Information
FORM 4: Project Funding/Financing Reference List
FORM 5: Project Information
FORM 5A: Site Information Sheet
FORM 5B: Certification of Consistency with the RC/EZ/EC-Iis Strategic Plan (form HUD-2990)
FORM 6: Financial Information
FORM 7: Summary of Loan Request
FORM 8 - Project Development Budget (Sources and Uses of Funds)
FORM 9: Application Narrative
FORM 10: Application Assurances and Certifications
FORM 11: Certification of No Material Changes
FORM 12: Corporate Borrowing Resolution
FORM 13: Disclosure of Lobbying Activities (SL-LL)
APPLICATION SUBMISSION CHECKLIST
(Form 1)
DUE TO THE COMPETITIVE NATURE OF HAC'S SHOP 2009 FUNDING ROUND, FAILURE TO PROPERLY COMPLETE AND
SUBMIT ALL FORMS REQUIRED, UNLESS OTHERWISE NOTED AS "OPTIONAL", ON THIS CHECKLIST MAY RESULT IN THE
REJECTION OF YOUR APPLICATION. CHECK ALL ITEMS INCLUDED AND ASSEMBLE YOUR APPLICATION PACKAGE
ACCORDING TO THIS SUBMISSION CHECKLIST.
Organization name:
TAB 1 - APPLICATION FORMS
a) Application Submission Checklist (Form 1)
b) Eligibility Questionnaire (Form 2)
c) Applicant Information (Form 3)
d) Project Funding/Financing Reference List (Form 4)
e) Project Information (Form 5)
f) Site Information Sheet (Form 5A)
g) Certification of Consistency with the RC/EZ/EC-Iis Strategic Plan - form HUD-2990 (Form 5B)
h) Financial Information (Form 6)
i) Summary of Loan Request (Form 7)
j) Project Development Budget, Sources and Uses of Funds (Form 8)
k) Application Narrative (Form 9)
l) Application Assurances and Certifications (Form 10)
m) Certification of No Material Changes (Form 11)
n) Corporate Borrowering Resolution (Form 12)
o) Disclosure of Lobbying Activities - SF-LLL (Form 13)
TAB 2 - ORGANIZATIONAL DOCUMENTS
Corporate
a) Articles of Incorporation [NEW SHOP APPLICANTS ONLY]
b) Bylaws [NEW SHOP APPLICANTS ONLY]
c) IRS Determination Letter [NEW SHOP APPLICANTS ONLY]
d) Current List of Board of Directors, including contact information.
e) Organizational Chart
f) Section 3 Compliance Plan, if SHOP loan requested for site development is $200,000 or more; see Appendix B.
g) Annual Report, brochures (optional)
TAB 3 - FINANCIAL DOCUMENTS
a) Organizational operating budget for current fiscal year
b) Interim financial statements (as of June 30, 2009 or later)
c) Complete financial audit report for most recent fiscal year or IRS Form 990 if audit is not required to be completed
d) Complete OMB Circular A-133 compliance audit for the most recent fiscal year, if applicable
e) Management Letter for most recent fiscal year, if applicable
f) Evidence of administrative funding for self-help housing efforts (i.e., executed copy of USDA RD 523 grant agreement, evidence of state funding
g) Quarterly Loan Status Report for 06/30/2009, if not already submitted [EXISTING SHOP AFFILIATES ONLY]
APPLICATION SUBMISSION CHECKLIST
(Form 1)
DUE TO THE COMPETITIVE NATURE OF HAC'S SHOP 2009 FUNDING ROUND, FAILURE TO PROPERLY COMPLETE AND
SUBMIT ALL FORMS REQUIRED, UNLESS OTHERWISE NOTED AS "OPTIONAL", ON THIS CHECKLIST MAY RESULT IN THE
REJECTION OF YOUR APPLICATION. CHECK ALL ITEMS INCLUDED AND ASSEMBLE YOUR APPLICATION PACKAGE
ACCORDING TO THIS SUBMISSION CHECKLIST.
Organization name:
TAB 4 - PROJECT DOCUMENTS
a) Copy of option or purchase contracts or settlement statements for each property, if available
b) Site approval letter from source of permanent financing, if available
c) Documentation of "as-is" site value (i.e., current site appraisal, tax assessment, comparables)
d) Comparable completed unit appraisal
e) Sample house plans for proposed units (maximum of 3 samples)
f) Unit construction budget for sample unit(s).
g) Site map or plat for each property for subdivision project
h) Location map for project(s)
i) Subdivision site plans
j) Completed HUD Environmental Review - RROF form HUD-7015.15, if available [required prior to disbursement of SHOP funds] See Appendix C.
k) Copy of Section 3 Compliance Plan- outlining how org. intends to meet New Hire and Contract requirements if/when org. has $200,000 for site improvements
l) Market study (optional)
m) Preliminary title report (optional)
n) Phase I Environmental (optional)
o) Site photos (optional)
p) Feasibility study (optional)
q) As-developed site appraisal, comparable (optional)
TAB 5 - LEVERAGING DOCUMENTS
a) Commitment letters from project financing sources
b) Commitment letters or MOU's from public or governmental entities, if applicable
c) Commitment letters or MOU's from local business, commercial lenders, private individuals, other grant/loan sources, if applicable
ELIGIBILITY QUESTIONNAIRE
(Form 2)
APPLICANT ORGANIZATIONS MUST RESPOND TO ALL QUESTIONS BELOW. THE QUESTIONNAIRE MUST BE INCLUDED AS PART OF THE
APPLICATION SUBMISSION.
Please select the appropriate response.
1. Is the applicant organization a public or private non-profit self-help housing organization? [Eligible applicants must have experience
in self-help housing and be chartered under state nonprofit laws or be public entities producing evidence of nonprofit or IRS 501(c)(3)
tax exempt status. The U.S. Department of Housing and Urban Development (HUD) has deemed municipalities as ineligible
applicants.]
2. Does the applicant organization have self-help housing experience or staff/consultants with self-help housing experience or relevant
housing development experience?
3. Does the applicant organization have an established or recurrent administrative funding source to cover the costs associated with
administering a self-help program and completing the proposed SHOP 2009 project? [If SHOP funds are awarded, applicant
organization must have evidence of committed administrative funding in place prior to closing on its SHOP 2009 award.]
4. Will the applicant organization's proposed self-help project/units serve eligible homebuyers that are low-income individuals or
families whose incomes do not exceed 80% of the median income for the area, as established by HUD?
5. Will the applicant organization's proposed self-help project require participant homebuyers to contribute a minimum of 100 hours of
sweat equity towards the construction of their own home and/or the homes of other homebuyers participating in the self-help
housing program?
6. Will the applicant organization's proposed self-help project development timeline meet the following tentative SHOP 2009 deadlines:
(a) if project consists of less than four units, SHOP-funded units must be completed and occupied by within two years of award date
(estimated 12/31/2012); or (b) if project consists of five or more units, SHOP-funded units must be completed and occupied by three
years of award date (estimated 12/31/2013)?
7. Will the applicant organization not require a homebuyer to make an up-front financial contribution to a housing unit other than cash
contributed for down payment or closing costs at the time of acquisition?
8. Has the applicant organization only submitted a SHOP 2009 application for funding to the Housing Assistance Council (HAC)? [If an
applicant organization applies for funds through more than one HUD SHOP NOFA applicant, it may be disqualified for any
funding.]
9. Will the applicant organization take specific energy-saving actions to incorporate energy-efficiency measures in the design,
construction, and/or rehabilitation of self-help housing units. [All SHOP units must meet Energy Star construction standards and use
Energy Star labeled products and appliances.]
If you responded "NO" to any of the above questions, your organization may not be eligible to receive HAC SHOP 2009
funding. Please contact Dierdra Pressley, Loan Officer, at (202) 842-8600, ext. 154 to provide clarification on your organization
and/or project's eligibility.
If you responded "YES" to all of the above questions, please proceed with completing the SHOP 2009 application.
APPLICANT INFORMATION
(Form 3)
Check here if New SHOP Applicant
SECTION I: CONTACT INFORMATION
Organization name:
Organization acronym:
Executive Director's name:
Executive Director's e-mail:
Application contact person:
Application contact e-mail:
Position title:
Address line 1:
Address line 2:
City:
State:
Zip:
Phone number: Ext.:
Fax number:
Contact person's e-mail:
Website:
SECTION II: ORGANIZATION INFORMATION
Type of organization:
Date incorporated (mm/yy):
Tax exempt status:
Federal Tax ID #:
Fiscal year end (mm/dd):
No. of FTE/PTE: Number of volunteers:
No. of minority staff: % of minority staff: #DIV/0!
No. of housing development staff: No. of board members:
No. of minority board members: % of minority board members: #DIV/0!
Congressional district no.:
Congressional representative's name:
SECTION III: SELF HELP HOUSING EXPERIENCE
Number of years of experience in self help housing: Number of Self-Help units completed, to date
New to Self Help Housing/ no units produced to date New Construction/ Subdivision
Less than 2 years New Construction /Scattered Sites
2-5 years Rehabbed
6-10 years TOTAL
More than 10 years
SECTION IV: TECHNICAL ASSISTANCE PROVIDER INFORMATION (IF APPLICABLE)
Provider organization:
Contact person:
Position Title:
Phone number: Ext.:
Private non-profit organizatio
Public non-profit organizatio
Housing Authority
Indian Tribe
Other (please describe)
Private non-profit organization Tax Status
Public non-profit organization
501(c)(3)
501(c)(4)
Other (please describe) Other (please describe)
Region 1 - Florida Non-Profit Housing
Region 2 - Little Dixie Community Action Agency
Region 3 - NCAll Research
Region 4 - Rural Community Assistance Corporation
PROJECT FUNDING/FINANCING REFERENCE LIST
(Form 4)
(attach additonal copies as needed)
PRE-DEVELOPMENT ACQUISITION
Financing Source/Entity: Financing Source/Entity:
Type of financing: Type of financing:
Contact name: Contact name:
Contact phone number: Contact phone number:
Amount of financing: Amount of financing:
Financing Source/Entity: Financing Source/Entity:
Type of financing: Type of financing:
Contact name: Contact name:
Contact phone number: Contact phone number:
Amount of financing: Amount of financing:
SITE CONSTRUCTION UNIT CONSTRUCTION
Financing Source/Entity: Financing Source/Entity:
Type of financing: Type of financing:
Contact name: Contact name:
Contact phone number: Contact phone number:
Amount of financing: Amount of financing:
Financing Source/Entity: Financing Source/Entity:
Type of financing: Type of financing:
Contact name: Contact name:
Contact phone number: Contact phone number:
Amount of financing: Amount of financing:
PERMANENT FINANCING SOURCES HOMEBUYER SUBSIDY SOURCES
Financing Source/Entity: Financing Source/Entity:
Type of financing: Type of financing:
Contact name: Contact name:
Contact phone number: Contact phone number:
Amount of financing: Amount of financing:
Financing Source/Entity: Financing Source/Entity:
Type of financing: Type of financing:
Contact name: Contact name:
Contact phone number: Contact phone number:
Amount of financing: Amount of financing:
OTHER SELF-HELP REFERENCE OTHER SELF-HELP REFERENCE
Contact name: Contact name:
Contact phone number: Contact phone number:
Contact email: Contact email:
Relation to Self Help activity Relation to Self Help activity
PROJECT INFORMATION
(Form 5)
SECTION I: PROPOSED SHOP 2009 PROJECT
Type of project (subdivision and/or scattered sites):
Name of proposed project:
Number of proposed units for project (total units):
Number of SHOP funded units: -
Number of persons expected to be assisted (including all household members):
AMI (%) served by project (minimum and maximum)
Proposed use of SHOP 2009 forgivable portion (90%):
SECTION II: PROJECT LOCATION
COUNTY 1 COUNTY 2 COUNTY 3
Insert County name here
State:
Number of proposed SHOP-funded units:
Town name:
Town population:
Urban or Rural area:
Within Metropolitan Statistical Area (SMSA)
HAC High Needs Area:
COUNTY 4 COUNTY 5 COUNTY 6
Insert County name here
State:
Number of proposed SHOP-funded units:
Town name:
Town population:
Urban or Rural area:
Within Metropolitan Statistical Area (SMSA)
HAC High Needs Area:
RC/EZ/EC - II INFORMATION
If any portion of proposed SHOP 2009 units will be located in a federally designated Empowerment Zones (EZs), renewal communities (RCs), or
enterprise communities (Ecs) designated by the United States Department of Agriculture (USDA) in Round II (EC-IIs), please complete form HUD-
2990, Certification of Consistency with RC/EZ/EC-IIs Strategic Plan. (This is form 17 in HAC application package.) A list of RC/EZ/EC-IIs can be
obtained from HUD's grant website at:
http://www.hud.gov/offices/cpd/economicdevelopment/programs/rc/tour/roundnumber.cfm
Name of RC/EZ/EC:
# of SHOP units in RC/EZ/EC:
SECTION III: PROJECT TIMELINE
SITE DEVELOPMENT MONTH/YEAR SELF-HELP MONTH/YEAR
Site control: Participant family recruitment:
HUD ER complete: Eligibility determined:
Zoning/permits approved: Construction/perm. loan approval:
Site development start: Participant family loan closings:
Site development complete: Unit construction start:
Unit construction start: Unit construction complete:
Unit construction complete:
Subdivision Appalachia
Scattered site Colonias
Both Indian Country
Mississippi Delta
N/A
Rural Yes Direct Subsidy toHomebuyers
Urban No Loan to Homebuyers
New Acquisition/Site development for future self-help housing projects
SITE INFORMATION SHEET
(Form 5A)
(Complete a sheet for each property)
Location of property:
Legal description of site, if available:
Describe topography of site:
Past and current uses of site:
Describe uses of abutting property:
Site Control
Option or Purchase Contract (please attach): Site Control: Yes No
Closing Date: Option Currently in Negotiation: Yes No
Terms: Sales Price:
Undeveloped Property- Property Information
Size (Acres): Estimated Number of Lots:
Price Per Acre: Price Per Lot:
Current Zoning/Use: Proposed Zoning/Use:
Developed Lots - Property Information
Number of Lots: Price per Lot:
Average Size of Lots: Zoning:
Site Market Value: As-is As- Developed
Market Value of Site: $ Market Value of individual lots:
Valuation Method (choose one):
Appraisal: Tax Assessment: Comparables:
Site Feature - Availability and Distance to Parcel Line
Electricity: Yes No Distance: Natural Gas: Yes No Distance:
Public Water: Yes No Distance: Public Sewer: Yes No Distance:
Individual septic systems: Yes No Individual wells: Yes No
Percolation tests completed and accepted by authorities: Yes No
Parcel has road frontage: Yes No Streets installed to City/County specs: Yes No
Streets accepted by City/County for
Yes No Street Lights present: Yes No
maintenance:
Curbs and gutters: Yes No Sidewalks present: Yes No
Elementary School Distance: Middle School Distance:
Senior High School Distance: Shopping District Distance:
Medical Services Distance: Employment Centers Distance:
SITE INFORMATION SHEET
(Form 5A)
(Complete a sheet for each property)
Location of property:
Legal description of site, if available:
Describe topography of site:
Past and current uses of site:
Describe uses of abutting property:
Site Control
Option or Purchase Contract (please attach): Site Control: Yes No
Closing Date: Option Currently in Negotiation: Yes No
Terms: Sales Price:
Undeveloped Property- Property Information
Size (Acres): Estimated Number of Lots:
Price Per Acre: Price Per Lot:
Current Zoning/Use: Proposed Zoning/Use:
Developed Lots - Property Information
Number of Lots: Price per Lot:
Average Size of Lots: Zoning:
Site Market Value: As-is As- Developed
Market Value of Site: $ Market Value of individual lots:
Valuation Method (choose one):
Appraisal: Tax Assessment: Comparables:
Site Feature - Availability and Distance to Parcel Line
Electricity: Yes No Distance: Natural Gas: Yes No Distance:
Public Water: Yes No Distance: Public Sewer: Yes No Distance:
Individual septic systems: Yes No Individual wells: Yes No
Percolation tests completed and accepted by authorities: Yes No
Parcel has road frontage: Yes No Streets installed to City/County specs: Yes No
Streets accepted by City/County for
Yes No Street Lights present: Yes No
maintenance:
Curbs and gutters: Yes No Sidewalks present: Yes No
Elementary School Distance: Middle School Distance:
Senior High School Distance: Shopping District Distance:
Medical Services Distance: Employment Centers Distance:
CERTIFICATION OF CONSISTENCY WITH THE RC/EZ/EC-Iis
STRATEGIC PLAN - FORM HUD-2990
(Form 5B)
APPLICANT ORGANIZATIONS PROVIDING A VALID FORM HUD-2990 FOR PROJECTS LOCATED IN
CURRENT ENTERPRISE ZONES OR ENTERPRISE COMMUNITIES RECEIVE UP TO FIVE (5) BONUS
POINTS IN THE SCORING OF THEIR APPLICATION.
CLICK HERE FOR LINK TO FORM
FINANCIAL INFORMATION
(Form 6)
ENTER FINANCIAL DATA IN THE AREAS BELOW FROM THE EARLIEST TO THE MOST RECENT FISCAL YEAR (I.E.,
Y1=9/30/06;Y1=9/30/07; Y3=9/30/08; INTERIM=06/30/09.
SECTION I: FINANCIAL STATUS OF ORGANIZATION
Enter Type of Financial Statements % Change
Y1 Y2 Y3 Interim Y2-Y1 Y3-Y2
Enter Period Ended:
What is the organization's current fiscal year's operating budget?
Statement of Financial Position or Balance Sheet
Current Assets #DIV/0! #DIV/0!
Cash & Equivalents #DIV/0! #DIV/0!
Fixed Assets #DIV/0! #DIV/0!
Land and Buildings #DIV/0! #DIV/0!
Total Assets #DIV/0! #DIV/0!
Current Liabilities #DIV/0! #DIV/0!
Total Liabilities #DIV/0! #DIV/0!
Unrestricted Net Assets #DIV/0! #DIV/0!
Temporarily Restricted Net Assets #DIV/0! #DIV/0!
Permanently Restricted Net Assets #DIV/0! #DIV/0!
Total Net Assets - - - - #DIV/0! #DIV/0!
Statement of Activities or Income Statement
Revenue #DIV/0! #DIV/0!
Expenses #DIV/0! #DIV/0!
Change in Net Assets - - - - #DIV/0! #DIV/0!
Key Ratios
Current #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Debt-to-Equity #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Debt Ratio #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
PLEASE EXPLAIN ANY RATIO INCREASES/DECREASES FROM PREVIOUS REPORTING PERIOD:
DEFINITION OF KEY RATIOS:
Current Ratio (liquidity) The ratio is an indicator of an organization's ability to pay its short-term liabilities (debt and payables) with its short-
term assets (cash, inventory, receivables). The higher the current ratio, the more capable the organization is of paying its obligations. A ratio
under 1 suggests that the organization would be unable to pay off its obligations if they came due within one year.
Debt-to-Equity Ratio (leveraging). The debt-equity ratio is another leverage ratio that compares an organization's total liabilities to its total
shareholders' equity (net assets). This is a measurement of how much suppliers, lenders, creditors and obligors have committed to the
organization versus what the shareholders have committed.
Debt Ratio (leveraging). The debt ratio compares an organization's total debt to its total assets, which is used to gain a general idea as to the
amount of leverage being used by a company. A low percentage means that the organization is less dependent on leverage, i.e., money
borrowed from and/or owed to others. The lower the percentage, the less leverage an organization is using and the stronger its equity
position. In general, the higher the ratio, the more risk that organization is considered to have taken on.
SUMMARY OF LOAN REQUEST
(Form 7)
NOTE: A FULL PROJECT DEVELOPMENT BUDGET IS ALSO A REQUIRED SUBMISSION. COMPLETE THE PROJECT
DEVELOPMENT BUDGET, SOURCES AND USES OF FUNDS (FORM 8 - PART I) OR SUBMIT IN ANOTHER FORMAT WITH
SIMILAR LINE ITEMS.
USES OF FUNDS SOURCES OF FUNDS
Other HAC Loan
SHOP 2009 Funds4 Total Request
1
Land Acquisition Costs
Land option
Land acquisition
Appraisals
Legal expenses for acquisition2
Acquisition closing costs
Other (please list) :
N/A
Sub-Total Acquisition Costs
Infrastructure Improvement Costs
Clearing/grading
Water/Sewer, Wells/septic installation
Utility hook-ups
Street/curbs/sidewalks
Impact/Tap fees
Permit fees
Engineering surveys/fees
Removal of environmental hazards3
Legal expenses for site development
Other (please list) :
N/A
Sub-Total Infrastructure Costs
Unit Construction Costs
Unit Construction
Other (please list) :
N/A
Sub-Total Unit Construction Costs
TOTAL AMOUNT OF REQUEST
1 SHOP reimbursement for eligible land acquisition costs are only allowable if SHOP funds are also requested and approved for land
acquisition.
2 Refer to Appendix A , "SHOP Eligible and Ineligible Expenses."
3 SHOP funds can only reimburse SHOP eligible costs incurred to resolve findings documented on Form HUD-4128, "Environmental
Assessment and Compliance Findings for the Related Laws" and or resolve findings indicated on the "Request for Release of Funds"
(RROF).
4 Eligible uses of HAC Loan Funds include predevelopment, acquisition and site development costs associated with development of
affordable housing. Current terms include 5% interest rate, 1% service fee, and 1-5 year term.
PROJECT DEVELOPMENT BUDGET
Sources and Uses of Funds
(Form 8 )
Organization Name:
Project Name:
Site Address/Location
Total Project Units
USES SOURCES TOTALS PER UNIT
Other HAC
Name of Funder (abbrev.) SHOP 2009 Funds
Amount #DIV/0!
Lien Position
Interest Rate 5.00%
Status
PREDEVELOPMENT
Site Appraisal #DIV/0!
Environmental/Assessment #DIV/0!
Engineering/Surveying #DIV/0!
Other #DIV/0!
Other #DIV/0!
Other #DIV/0!
Total Pre-Development #DIV/0!
ACQUISTION
Land Option #DIV/0!
Land Acquisition #DIV/0!
Appraisal #DIV/0!
Legal Expenses for Acquisition #DIV/0!
Acquisition Closing Costs #DIV/0!
Other #DIV/0!
Other #DIV/0!
Other #DIV/0!
Total Acquisition #DIV/0!
INFRASTRUCTURE IMRPOVEMENTS
Clearing/Grading #DIV/0!
Water/Sewer/ Wells/ Septic #DIV/0!
Utility hook-ups #DIV/0!
PROJECT DEVELOPMENT BUDGET
Sources and Uses of Funds
(Form 8 )
Organization Name:
Project Name:
Site Address/Location
Total Project Units
USES SOURCES TOTALS PER UNIT
Other HAC
Name of Funder (abbrev.) SHOP 2009 Funds
Streets/Curbs/Sidewalks #DIV/0!
Impact/Tap fees #DIV/0!
Permit Fees #DIV/0!
Removal of Environmental Hazards #DIV/0!
Other #DIV/0!
Other #DIV/0!
Other #DIV/0!
Total Infrastructure Improvements #DIV/0!
PROJECT-RELATED SOFT COSTS
Accounting and Audit #DIV/0!
Architect #DIV/0!
Engineering Design #DIV/0!
Administration #DIV/0!
Construction Bond Fee #DIV/0!
Construction Loan Interest #DIV/0!
Construction Loan Fee #DIV/0!
Consultant Fees #DIV/0!
Developer Fees #DIV/0!
Home Buyer Preparation #DIV/0!
Inspection Fees #DIV/0!
Insurance, Liability #DIV/0!
Legal Fees #DIV/0!
Financing Fees #DIV/0!
Marketing Fees #DIV/0!
Soft Cost Contingency #DIV/0!
Taxes #DIV/0!
Title and Recording #DIV/0!
Other #DIV/0!
PROJECT DEVELOPMENT BUDGET
Sources and Uses of Funds
(Form 8 )
Organization Name:
Project Name:
Site Address/Location
Total Project Units
USES SOURCES TOTALS PER UNIT
Other HAC
Name of Funder (abbrev.) SHOP 2009 Funds
Other #DIV/0!
Other #DIV/0!
Other #DIV/0!
Other #DIV/0!
Contingency #DIV/0!
Total Project-Related Soft Costs #DIV/0!
Subtotal #DIV/0!
UNIT CONSTRUCTION
Unit Construction #DIV/0!
Building Permits/Fees #DIV/0!
Other #DIV/0!
Other #DIV/0!
Other #DIV/0!
Contingency #DIV/0!
Total Unit Construction #DIV/0!
Total Development Costs (pre-ddevelopment, acquisition, infrastructure improvements, project-related costs) #DIV/0!
Total Development Costs (pre-ddevelopment, acquisition, infrastructure improvements, project-related costs, unit construction) #DIV/0!
DEVELOPMENT GAP #DIV/0!
If there is a development gap between the Sources and Uses, please explain below.
PROJECT DEVELOPMENT BUDGET
Sources and Uses of Funds
(Form 8 )
Organization Name:
Project Name:
Site Address/Location
Total Project Units
USES SOURCES TOTALS PER UNIT
Other HAC
Name of Funder (abbrev.) SHOP 2009 Funds
APPLICATION NARRATIVE
(Form 9)
PLEASE RESPOND TO ALL QUESTIONS. IF A QUESTION DOES NOT APPLY, PLEASE INDICATE
WITH AN "N/A."'
CLICK HERE FOR LINK TO FORM
APPLICATION ASSURANCES AND CERTIFICATIONS
(Form 10)
As part of your application for SHOP funding, you, as the official authorized to sign on behalf of your organization, must provide the
following assurances and certifications. By submitting this form, you are certifying that to the best of your knowledge and belief, all
assertions listed below are true and correct. Furthermore, you understand that intentional misrepresentations of the facts may result
in the rejection of the application or denial of funding.
1. The information contained in the SHOP 2009 application and related attachments hereto is current and complete.
2. As part of your application for SHOP funding, you, as the official authorized to sign on behalf of your organization, must
provide the following assurances and certifications. By submitting this form, you are certifying that to the best of your
knowledge and belief, all assertions listed below are true and correct. Furthermore, you understand that intentional
misrepresentations of the facts may result in the rejection of the application or denial of funding.
3. The organization will not require homebuyer families to make an up-front financial contribution to a housing unit other than
cash contributed for down payment or closing costs at the time of acquisition.
4. The organization is not currently debarred or suspending from receiving Federal contracts or certain subcontracts and from
certain types of Federal financial or nonfinancial assistance and benefits or on the Excluded Parties List System (EPLS). (The
EPLS is the electronic version of the List of Parties Excluded from Federal Procurement and Nonprocurement Programs - website:
http://epls.arnet.gov/)
5. The organization is in good legal standing as of the date of application submission. (If awarded SHOP 2009 funds, a "Certificate of
Good Standing" must be submitted as part of the loan closing documents. An organization in good standing means all required reports and
taxes have been filed and annual registration fees paid, as of the date the certificate has been issued, which officially proves the company has
not been suspended or canceled.)
6. No Federal funds appropriated have been paid, or will be paid, by or on behalf of the applicant, to any person for influencing or
attempting to influence an officer or employee of any agency, a Member of Congress, and officer or employee of Congress, or an
employee of a Member of Congress, in connection with awarding of SHOP loan/grant or its extension, renewal, amendment or
modification. (Complete SF-LLL, Disclosure of Lobbying Activities, to disclose lobbying activities pursuant to 31 U.S.C. 1352. If not,
applicable, indicate "non-applicable" on form.)
7. The organization has legal authority to apply for Federal assistance, has the institutional, managerial and financial capability
(including funds to pay the non-Federal share of program costs) to plan, manage and complete the project as described in the
application and the governing body has duly authorized the submission of the application, and authorized me as the official
representative of the organization to act in connections with the application and to provide any additional information as may be
required. (A Corporate Borrowing Resolution may be submitted with the application or at loan closing, if approved.)
8 The organization must incorporate energy-efficiency measures in the design and construction of self-help housing units. All
newly constructed units assisted with SHOP funds under the NOFA must qualify and receive Energy Star Certification by an
independent Home Energy Rater (HER) upon completions and only Energy Star labeled products and appliances may be used in
these units.
Name of Organization
Signature of Executive Director/President Date
Printed Name
CERTIFICATE OF NO MATERIAL CHANGES
(Form 11)
(To be completed by current SHOP borrowers only)
I certify that
has previously submitted to the Housing Assistance Council the documents indicated below, and that no material changes
have occurred in the documents since the submission of the last SHOP application.
Note: If the last time your organization applied for SHOP funds was 2005 (FY 2005 funding round), you must submit
updated documents.
Year Document No Material Changes
Document
Submitted ("Yes" or "No")
Articles of Incorporation
Bylaws
IRS Determination Letter
Please only submit items for which a "Yes" is indicated. If "No" to all, DO NOT resubmit these documents.
Signature of Executive Director/President
Printed Name and Title
Date
CORPORATE BORROWING RESOLUTION
(Form 12)
The Governing Board of Directors of
Hereby authorizes the submission of a loan application, the incurring of and indebtedness, the execution of a loan agreement and
any amendments thereto, a promissory note, and any other documents necessary to secure a loan from the Housing Assistance
Council.
Whereas,
(name of corporation)
which is (hereinafter referred to as "Corporation") is a corporate entity established under the laws of the State of
and empowered to own property, borrow money, and give security for loans.
Housing Assistance Council (hereinafter referred to as “HAC”) is authorized to make loans for hard and soft costs associated with
affordable housing development, including: predevelopment, land acquisition, site development, unit rehabilitation and
construction, working capital and equity capital. Eligible applicants for SHOP funds include nonprofit organizations, Indian Tribes,
housing authorities, units of local government, and other entities eligible for federal funding.
The Corporation wishes to obtain from HAC a loan for the development of
(project type), (hereinafter referred to as “Project”) on the property located
at
(Address/location of property)
It is now resolved that the Corporation shall submit to HAC an application for a loan for the project to be developed in
the County of (county) in the State of
(State).
If the loan is approved, the Corporation is hereby authorized to incur indebtedness in an amount not to exceed the amount approved
by HAC and to enter into a loan agreement with HAC for the purposes set forth in the loan application and approved by HAC. It
also may give a promissory not and execute security and other instruments required by HAC to evidence and secure the
indebtedness.
The Corporation is further authorized to request amendments, including increases in the loan amount up to the amounts approved
by HAC, and to execute any and all documents required by HAC to evidence and secure these amendments.
The Corporation authorizes (Name and Title of Authorized Officer)
(Name and Title of Authorized Officer)
CORPORATE BORROWING RESOLUTION
(Form 12)
To execute in the name of the Corporation, the loan application and the loan agreement, promissory note, and any amendments
thereto.
The Corporation authorizes (Name and Title of Authorized Officer)
(Name and Title of Authorized Officer)
To execute in the name of the Corporation, any and all documentation required by HAC for the disbursement of funds during the
term of the loan.
Passed and adopted on this the day of , . by the following vote:
Ayes: Abstain:
Nayes: Absent:
The undersigned, secretary of the Corporation does hereby by attest and certify that the foregoing is a true and full copy of a
resolution of the Governing Board of Directors adopted at a duly convened meeting on the date mentioned above, and that said
resolution has not been altered, amended or repealed.
(Date)
(Secretary)
* This is intended to be model for resolutions authorizing loan applications. Applicants may use their own format if it contains substantially all
the authorizations in the model.
CORPORATE BORROWING RESOLUTION
(Form 12)
DISCLOSURE OF LOBBYING ACTIVITIES (SL-LL)
(Form 13)
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal
recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing,
pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to
make payment to any lobbying entity for influencing or attempting to influence an officer or employee of
any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing
and material change report. Refer to the implementing guidance published by the Office of Management and
Budget for additional information.)
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