Single Family

Part II: Uniform Housing Programs Application UNIFORM HOUSING PROGRAMS APPLICATION FOR NON RENTAL DEVELOPMENT ACTIVITIES Texas Department of Housing and Community Affairs (TDHCA) Mailing Address: P.O. Box 13941, Austin, Texas 78711-3941 Physical Address: 507 Sabine, Austin, TX 78701 TABLE OF CONTENTS 1. APPLICANT INFORMATION A. APPLICANT CONTACT INFORMATION ............................................................................ 2 B. APPLICANT LEGAL DESCRIPTION .................................................................................. 2 C. APPLICANT DISCLOSURES ............................................................................................. 2 D. APPLICATION TECHNICAL ASSISTANCE AND CAPACITY BUILDING ............................ 2 E. CONSULTANT OR ADMINISTERING AGENT .................................................................... 3 2. LOCATION & JURISDICTION INFORMATION of the APPLICATION ACTIVITY ......... 3 3. FUNDING REQUEST A. PROGRAM SET-ASIDE................................................................................................... . 6 B. PROGRAM ELIGIBLE ACTIVITIES.................................................................................... 6 C. FUNDING REQUEST......................................................................................................... 6 D. PREVIOUSLY AWARDED STATE AND FEDERAL FUNDING ........................................... 6 4. POPULATIONS SERVED A. PROPOSED LOW INCOME LEVELS TO BE SERVED ...................................................... 8 B. RELOCATION ................................................................................................................... 8 C. SPECIAL NEEDS .............................................................................................................. 8 EXHIBITS……………………………………………………………………………………………………..9 Part A. Certification of Applicant .......................................................................................... 9 Part B. Previous Participation and Background Certification Form .................................. 11 Part C. Evidence Of Nonprofit Organization ...................................................................... 15 Part D. Historically Underutilized Business Participation Certification Form ................... 18 Part II, Page 1 UNIFORM HOUSING PROGRAMS APPLICATION FOR NON RENTAL DEVELOPMENT ACTIVITIES Texas Department of Housing and Community Affairs (TDHCA) Mailing Address: P.O. Box 13941, Austin, Texas 78711-3941 Physical Address: 507 Sabine, Austin, TX 78701 Special Notation Symbols Used in the Application:  Attachment may be required. 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, an d 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 Applicant’s behalf. Applicant’s Authorized Representative’s Signature Representative’s Printed Name, Title Date 1. APPLICANT INFORMATION Provide the contact data for the Applicant’s staff person who is responsible for application and contract administration. This contact will not be the consultant or the end service provider. A. APPLICANT CONTACT INFORMATION Applicant Legal Name: Applicant Contact Name: Applicant Mailing Address: City, State, ZIP: Applicant Physical Address: City, State, ZIP: B. APPLICANT LEGAL DESCRIPTION Legal Form of Applicant is/will be a (check only one): Applicant is legally formed? No Yes If yes, the Taxpayer Identification # (TIN) is:______________ Non-profit Corporation Other Designations (Mark all that apply.): C. APPLICANT DISCLOSURES CHDO Certified Self Help Center Historically Underutilized Business No CHDO COG Federal Tax Exemption Email: If Applicant’s “Physical Address” is different from the “Mailing Address,” provide the physical address below: Phone: Fax: Applicant is in good standing with the Secretary of State? Yes The State Filing # is:  If “Yes” is answered for any of items “1” through “5” below, then provide behind Tab 1 a thorough explanation of the circumstances and copies of correspondence regarding the status of this ruling from the authority that made this determination. Has the Applicant: 1) been delinquent on filing of any federal or state tax returns? No Yes 2) received federal or state findings? No Yes 3) been delinquent on federal or state debt? No Yes 4) been debarred from HUD1 or other federal programs? No Yes 5) filed bankruptcy in the last 10 years? No Yes 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? No Yes 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. Part II, Page 2 1 If “Yes”, it was sponsored by: The activity was: Workshop TDHCA Other (Sponsor Name): Capacity Building Funds Predevelopment Funds Field Office Assistance Other (describe activity): E. CONSULTANT OR ADMINISTERING AGENT If a Consultant or Administering Agent was used to complete the application, then provide the following information: Consultant Name: Contact Name: Mailing Address: City, State, ZIP: Phone: Fax: Email: Proposed Fee: $ Taxpayer ID # (TIN): Does the Consultant/Administering Agent qualify as a HUB? No Yes Is there a direct or indirect, financial, guarantor or other interest with Applicant or other team members? If “Yes,” describe relationship(s): No Yes 2. LOCATION & JURISDICTION INFORMATION of the APPLICATION ACTIVITY Local Jurisdiction Name: Local Official with Jurisdiction over the Activity site is the: Local Official Name: Mailing Address: City, State, ZIP: State Senator: State Representative: U.S. Representative: List the County or Counties in which the award will be used 1. TDHCA State Service Region: Mayor County Judge Fax: District #: District #: District #: Other: Phone: 2. 3. 4. Check the box below which best describes the area within the county that will be served. Entire County or Entire County except for PJ Cities or List Specific City or Cities that will be served: Entire County or Entire County except for PJ Cities or List Specific City or Cities that will be served: Entire County or Entire County except for PJ Cities or List Specific City or Cities that will be served: Entire County or Entire County except for PJ Cities or List Specific City or Cities that will be served: Part II, Page 2 3. PROJECT NAME & LOCATION Development Name: Development Address: City: County: Zip: CHAS Region: Census Tract: A. THE PROJECT/LOCATION is Listed National Register Historic Places? Listed Local Register of Historic Places? Municipal Historic District? Within a Federal Historic District?     Yes Yes Yes Yes     No No No No In Qualified Census Tract? Difficult Development Area? In an Enterprise Zone?    Yes Yes Yes    No No No B. EVIDENCE OF SITE OR PROPERTY CONTROL   Warranty Deed (recorded) * Earnest Money Contract   Contract for Deed Contract for Lease / / / /   Purchase Option Option to Lease   / / In Escrow Letter of Intent / / Expiration of Contract or Option: Anticipated Closing Date: Expiration Feasibility Contingency: Expiration of Financing Contingency: * If the property has been acquired prior to this Application, please submit a closing statement C. ACQUISITION INFORMATION Acquisition Cost Seller: (name) City: State: $ Address: Zip: Phone: ( )  No  Yes  / Acquisition Date: / 200 Is seller affiliated with applicant, or any entity or individual affiliated with the applicant? If yes, please explain: Did seller acquire the property through foreclosure or deed in lieu of foreclosure?  Yes No Part II, Page 4 D. DESCRIPTION OF SUBJECT PROJECT A. TYPE    Plan # Detached Single Family Residence Subdivision For Sale Residential Condominiums Elderly Housing Floors Number   Detached Single Family Residences on Scattered Sites Mobile/Manufactured Homes  Other (describe): Bedrooms Other Rms Bathrooms Size in SF Sales Price $ TOTAL: AVERAGE: $ E. SITE DESCRIPTION Size: acres sq. feet # of Lots: Aver Lot Size: No X Is the property in the process of re-zoning  Yes  No Is the property zoned for single family housing?  Yes  Current Zoning:_________________________ Flood Zone Designation: \ Electric Gas Storm Drains Proposed Zoning:__________________ Describe Topography: Water Fire Hydrants Sewers Street Lights Sidewalks Paved Streets Concrete Curbs If any are proposed, provide a schedule of completion including costs attributable to the project. F. CONSTRUCTION SPECIFICATIONS (Mark all applicable categories) Foundation: Wall Structure Exterior  Slab on Grade  Wood Frame  Brick Veneer  Stone Veneer  Comp. Shingle  Built-up Rock  Drywall        Grade Beams Steel Stud Frame HardiBoard or Plank Plywood/Composition Laminated Shingle Composition Roll Plaster Walls Evaporative Cooling  Post-Tension Slab  Concrete Block  Wood Siding  Vinyl Siding  Wood Shingle  Concrete Tile  Heat Pump System  Baseboard Heating         Pier & Beam Struct Integr Panel Stucco Wood Trim Galvanized Metal Mission Tile Central Heat & A/C Flr/Wall Furnace Roof Interior Walls HVAC  Forced Air Furn  G. INTERIOR FEATURES & SPECIFICATIONS (Mark all applicable features)  Range & Oven  Refrigerator  Hood & Fan  Microwave  Garbage Disposal  Washer & Dryer Part II, Page 5  Dishwasher  Wash/Dry Connect     Ceiling Fans Vinyl Flooring Tub Enclosure Fiberglass Tub/Shwr  Individual Wtr Htrs  Carpeting  Steel Tub  Tile Counter Tops  Fireplace  Hardwood Floors  Stall Shower  Laminated Cntr Tops  Monitored Security  Other Flooring  Tile Tub/Shwr Walls  Cultured Mrble Tops PARKING SPACES per HOUSE  Garages  Carports  Uncovered Parking H. VALUATION INFORMATION 1. APPRAISED VALUE (If Applicable, Provide Documentation) Land Only: Lots Only: Projected Houses & Lots: Appraiser: City: $ $ $ Address: State: Zip Phone ( ) Date of Valuation: Date of Valuation: Date of Valuation: / / / / / / 200 200 200 2. TAX ASSESSED VALUE (Provide Documentation) Land: Building: Total Assessed Value: $ $ $ Assessment for the Year: Valuation by: 4. Request For TDHCA Funds A. Complete the table below to describe this application’s funding request. Requested Funds are in the formaward will be in the form of a loan, If the of a: the requested terms are: Amortization (Yrs.) Term (Yrs.) TDHCA Programs for which this Application will be used: Requested Amount Grant HOME Pre-Development Funds HOME CHDO Operating Expense Funds HOME CHDO Development Funds HOME CHDO Eligible Down Payment Assistance Funds HOME Administration Funds (4% of Activity Funds) Housing Trust Fund TX Bootstrap Loan Program $ $ $ $ $ $ $ Loan B. PREVIOUSLY AWARDED STATE AND FEDERAL FUNDING Has this Applicant previously received TDHCA funds? No Yes Has this Applicant previously received non-TDHCA federal funding? No Yes Will this Applicant receive non-TDHCA federal funding for costs described in this application?  If the answer to any of the above questions is “Yes,” then include a funding description behind Tab 1 that at a minimum inclu des the source, amount, term and any associated rental restrictions. If the award was from TDHCA, then the TDHCA contract number should also be provided No Yes Part II, Page 6 Interest Rate (%) . C. OTHER SOURCES of FUNDS 1. INTERIM CONSTRUCTION LOAN Loan Amount Payment Amt: Other Terms: Source: Address: State: 2. OTHER FINANCING Loan Amount Payment Amt: Other Terms: Source: Address: State: Zip: Contact: City: Phone: ( ) $ $ Int. Rate: Lien Priority: % Amortization: Commitment Date: yrs / Term / 200 yrs Zip: Contact: City: Phone: ( ) $ $ Int. Rate: Lien Priority: % Amortization: Commitment Date: yrs / Term / 200 Yrs Part II, Page 7 5. POPULATIONS 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. Bootstrap HOME 0 - 30% AMFI(1) 31- 50% AMFI 51 – 60% AMFI 61 – 80% AMFI Total units assisted by Program Notes: (1) TDHCA is committed to targeting funds towards households earning less than 30 percent of the area median family income. As such, the applicant may receive points for setting such units aside as discussed in the program’s rules. B. RELOCATION Is temporary relocation of a current tenant(s) anticipated during the rehabilitation on period? No Yes Is permanent relocation of a current tenant(s) anticipated during or after the rehabilitation period? No Yes  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  Only Applicants applying for Special Needs, Persons with Disabilities, or Olmstead Set-Aside funds 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. Additional scoring criteria has been established under each of the eligible activities to assist the Department in reaching its goal. To qualify for these points, unless approval by the Department is granted, this application will serve only persons that qualify under the following HUD special needs or persons with disabilities designations and the Olmstead Supreme Court decision: persons with drug and alcohol addictions colonia residents persons with disabilities victims of domestic violence elderly persons persons with HIV/AIDs homeless populations migrant farm workers. Part II, Page 8 HTF EXHIBIT 1. PARTICIPANTS IN THE APPLICATION INFORMATION Part A. Certification of Applicant This certification must be signed and filed by persons who are authorized to execute the HOME contract.. I hereby apply to the Texas Department of Housing and Community Affairs for approval to participate in this Application activity as the Applicant. I certify that all statements made by me in the “Participants in the Application Information” section of the Application and related exhibits are true, complete, and correct and are made in good faith. 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 during 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 government 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 under 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 default, 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 concerning 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 Government 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 Americans 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) 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 Part II, Page 9 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 though 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: Applicant Printed Name: Applicant’s Title:_______________________________________________ Date: 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, Low Income Housing Tax Credit = LI, Office of Colonia Initiatives = OC, Tax-exempt Private Activity Mortgage Revenue Bond = TP, 501 (c)(3) Tax-exempt Mortgage Revenue Bond = TM: Part II, Page 10 EXHIBIT 1. PARTICIPANTS IN THE APPLICATION INFORMATION Part B. Previous Participation and Background Certification Form (also referred to as the “Previous Participation Certification in the HTC QAP) Part B, Sections 1, 2, and 3 must be completed by persons who are authorized to execute control of TDHCA assisted affordable housing or related supportive services activities. Review the information for accuracy and full disclosure as incomplete forms or disclosure may result in disqualification of the application or an administrative deficiency. If the Applicant has no previous experience with TDHCA funding, then they should check the “No” box in response to the “Has the Applicant previously received TDHCA funds?” question in “Section 3, Part D. Previous Awarded State and Federal Funding instead of completing Exhibit 1, Part B, Sections 1 and 2. If the Applicant has no previous experience with other state affordable housing funding, then they should check the “No” box in response to the “Has this Applicant previously received non-TDHCA federal funding?” question box in “Section 3, Part D” instead of completing Exhibit 1, Part B, Section 3. Applicant Printed Name: List the “Applicant Legal Name” for each current or pending TDHCA application of the Applicant): SECTION 1. EXPERIENCE WITH TDHCA HOUSING CONSTRUCTION/REHAB. PROGRAMS Mort. Revenue Bonds Total # of Units Other: Describe TDHCA Activity ID #2 Term of Participation or Contract Begin Term of Participation or Contract End Property Name Property City mm/yy mm/yy TDHCA Activity ID #: Final Development, Contract or Loan Number used by TDHCA to identify the development or act ivity. Disclosure: Check the box if the development or activity has known past non-compliance or defaults, technical or otherwise. If disclosures exist, then provide on separate document a description of the issue and note whether it has been cured. Examples of disclosures include: defaults, mortgage relief, assignments, foreclosures, material/mechanic’s liens, legal action, issuance of IRS Form 8823, instances of non- compliance with local building codes or planning regulations, and other program findings of non-compliance. 2 3 Part II, Page 11 Disclosure3 HOME HTC HTF EXHIBIT 1. PARTICIPANTS IN THE APPLICATION INFORMATION PART B. PREVIOUS PARTICIPATION AND BACKGROUND CERTIFICATION FORM SECTION 2. EXPERIENCE WITH TDHCA SERVICE RELATED ACTIVITIES (CSBG, CEAP, WAP, ENTERP, and HOME and HTF Funds that are not used for Rental Construction) ENTERP TDHCA Activity ID #4 Term of Participation or Contract Begin Term of Participation or Contract End Disclosure 5 Contract Amount CSBG Grantee, Contractor, or Sub-Recipient Name Grantee, Contractor, or Sub-Recipient City CEAP WAP HTF Other: Describe HOME mm/yy mm/yy TDHCA Activity ID #: Final Development, Contract or Loan Number used by TDHCA to identify the development or activity. Disclosure: Check the box if the development or activity has known past non-compliance or defaults, technical or otherwise. If disclosures exist, then provide on separate document a description of the issue and note whether it has been cured. Examples of disclosures include: defaults, mortgage relief, assignments, for eclosures, material/mechanic’s liens, legal action, issuance of IRS Form 8823, instances of non- compliance with local building codes or planning regulations, and other program findings of non-compliance. 4 5 Part II, Page 12 EXHIBIT 1. PARTICIPANTS IN THE APPLICATION INFORMATION PART B. PREVIOUS PARTICIPATION AND BACKGROUND CERTIFICATION FORM SECTION 3. N ATIONAL 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): 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 Applicant’s participation in this state’s affordable housing programs is provided in Subsection (c). Applicant’s Signature Date Applicant’s Printed Name Subsection (b). State Agency Response to Request for Compliance Status (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 2004 calendar year. State Agency Name: Address: City: State: ZIP: Phone: Uncorrected Uncorrected Uncorrected Contact: 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 Refusal to lease to persons with Section 8 vouchers. Such finding is Corrected Determination of a violation under the Fair Housing Act. Such finding is Corrected 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? If “No,” what formal or informal action has been taken by your agency? Yes No 3. Is there other information you wish to share regarding compliance status? This response represents this agency’s evaluation of the Applicant’s compliance status as of February 28, 2004. 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 Patricia Murphy at (512) 475-3140. Your prompt response and any information that you are able to share is greatly appreciated. Part II, Page 13 EXHIBIT 1. PARTICIPANTS IN THE APPLICATION INFORMATION PART B. PREVIOUS PARTICIPATION AND BACKGROUND CERTIFICATION FORM SECTION 3. N ATIONAL PREVIOUS PARTICIPATION AND BACKGROUND CERTIFICATION FORM Applicants should review the information for accuracy and full disclosure as incomplete forms or disclosure may result in disqualification of the application or an administrative deficiency. Applicant Printed Name: Subsection (c). Participation in Non-Texas State Housing Construction/Rehab. Programs (To be completed by Applicant.) Total # of Units Mort. Revenue Bonds Agency Activity ID #6 Term of Participation or Contract Begin Term of Participation or Contract End Property Name Property City Other: Describe mm/yy mm/yy Activity ID #: Final Development, Contract or Loan Number used by the agency to identify the development or activity. Disclosure: Check the box if the development or activity has known past non-compliance or defaults, technical or otherwise. If disclosures exist, then provide on separate document a description of the issue and note whether it has been cured. Examples of disclosures include: defaults, mortgage relief, assignments, foreclosures, material/mechanic’s liens, legal action, issuance of IRS Form 8823, instances of non- compliance with local building codes or planning regulations, and other program findings of non-compliance. 6 7 Part II, Page 14 Disclosure7 HOME HTC EXHIBIT 1. PARTICIPANTS IN THE APPLICATION INFORMATION Part C. Evidence Of Nonprofit Organization  Only nonprofit organizations will complete this section. SECTION 1. ORGANIZATION CERTIFICATION Organization Name: Legal Status: 501(c)(3) 501(c)(4) tax-exempt under 501(a) Date of legal formation of Nonprofit Organization: a) PHA other (specify) Is the Applicant comprised of a joint venture between a Nonprofit Organization and for-profit entity? Yes No. If “Yes”, will this nonprofit organization Control 8 the Applicant? Yes No. What is the ownership percentage of this nonprofit organization? b) Describe the nonprofit’s participation in the development: c) Describe the nonprofit’s participation in the operation of the development throughout the compliance and/or extended use period: d) Does the nonprofit have prior experience Yes No. If “Yes”, describe such experience: in owning, managing or developing affordable housing? 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 Other (specify) Is the nonprofit (or related subsidiary entity) assured of owning an interest in the development throughout the compliance pe riod? Yes No Yes No If “Yes”, explain: f) g) Will the nonprofit be contributing funds to the development? h) Will the nonprofit receive any part of the development or management fees paid in connection with the development? No If “Yes”, explain: Yes Control - the possession, directly or indirectly, of the power to direct or cause the direction of the management 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 partner interest in a limited partnership, or designation as a managing general partner or the managing member of a limited liability company. 8 Part II, Page 15 i) How many full time staff members does the nonprofit have? proposed development? Describe their activities: How many of them will substantially participate in the 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 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: l) 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 indirectly, with any persons or entities involved 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 meeting 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, corporation, or other entity? Yes No The undersigned applicant and nonprofit entity hereby each certify that, to the best of its knowledge, all of the forgoing information is correct, complete and accurate. 9 Applicant/Owner Name By: Nonprofit Name By: Authorized Signature Authorized Signature Name: Title: Date: Name: Title: Date: 9 If different, both the nonprofit organization and the applicant must sign. Part II, Page 16 EXHIBIT 1. PARTICIPANTS IN THE APPLICATION INFORMATION Part C. Evidence of Nonprofit Organization SECTION 2. L IST OF THE NONPROFIT ORGANIZATION’S BOARD MEMBERS, D IRECTORS AND OFFICERS Name: Title: Home Address: City: St.: Zip: Phone: ( ) Yes Yes Ext: No No Occupation: Fax: ( ) Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity? 10 (2) have a relationship, as Affiliate or otherwise, w/ members of the Applicant or Development Team? 11 Name: Home Address: City: St.: Zip: Title: Phone: ( ) Yes Yes Ext: No No. Occupation: Fax: ( ) Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity? (2) have a relationship, as Affiliate or otherwise, w/ members of the Applicant or Development Team? Name: Home Address: City: Occupation: St.: Zip: Title: Phone: Fax: ( ( ) ) Ext: Yes Yes No No Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity? (2) have a relationship, as Affiliate or otherwise, w/ members of the Applicant or Development Team? Name: Home Address: City: Occupation: St.: Zip: Phone: Fax: ( ( ) ) Title: Ext: Yes Yes No No Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity? (2) have a relationship, as Affiliate or otherwise, w/ members of the Applicant or Development Team? Name: Home Address: City: St.: Zip: Phone: ( ) Title: Ext: Yes Yes No No Occupation: Fax: ( ) Does the individual (check all that apply): (1) serve as a private individual acting in a private capacity? (2) have a relationship, as Affiliate or otherwise, w/ members of the Applicant or Development Team? (Make additional copies of this form as required for additional board members, directors, and officers.) An individual is considered to be acting in a private capacity if the individual is not an employee of a public body and is n ot being paid by a public body while performing functions in connection with the nonprofit organization. A public body is any state, city, county, town, township, village or other general purpose political subdivision of the state. 11 If “Yes”, attach explanation of such relationship to this form. 10