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									                  PART B. APPLICATION FORM




2008 SHDP 400 Application Form               Part B, Page 1
SECTION 1.                APPLICANT/OWNER INFORMATION

A. Project Name           Project Name
   and Address            Address
                          City                                                              Zip Code
                          County


B. Applicant/Owner        Organization Name
   Information            Address
                          City                                State                Zip Code
                          Federal Taxpayer ID Number
                          Contact Person
                          Title
                          Telephone                                        Fax
                          E-mail
                          What entity will own the project?
                          (Note: the Applicant must be the owner of the development)


                          Person authorized to negotiate and sign legal contracts for the organization
                          Name
                          Title
                          Address
                          Telephone                                        Fax
                          E-mail


C. Type of                       Local government
   Organization
                                 Nonprofit organization   Date of IRS 501(c)(3) determination letter


                          If Applicant is a nonprofit organization, attach as Exhibit 1 a copy of each of the following:
                          - Articles of Incorporation
                          - Bylaws
                          - IRS 501(c)(3)determination letter
                          - Current list of all members of the Board of Directors, including name, address, and
                          beginning and ending dates of term


                          Provide a brief history of the Applicant Organization, including purpose, current
                          programs, number of staff persons, recent initiatives, etc.




  2009 SHDP 400 Application Form                                                                         Part B, Page 2
                         Has the Applicant organization or Management Agent received an unsatisfactory rating on publicly funded project or
D.   Administrative      been debarred for any period of time? Or have outstanding compliance issues with HUD or NCHFA?
     Restrictions
                                        Yes                                                            No


                         Has the Applicant organization been involved in any lawsuit?
                                           Yes                                                          No


                         Are there any outstanding judgments against the Applicant organization?
                                        Yes                                                            No

                         Has the Applicant organization been involved in mortgage default within the last 5 years on
                         any federally or state funded project?

                                        Yes                                                            No

                         If any of the above responses was "Yes", provide a short explanation (attach additional sheets
                         if necessary):




E.   Audit               Attach as Exhibit 2 , the Applicant's two most recent annual audited financial statements or
                         certified statement of Revenues and Expenses.


F.   Experience                    Number of units developed by Applicant in past 5 years.
                                   Number of units developed by Consultant in past 5 years, if applicable.
                                   Number of units managed by Property Manager currently

                         As Exhibit 3, describe the rental housing experience of the Applicant within the last five (5)
                         years. For each previous project, include the name of the project, number of units, type of
                         financing, and indicate whether financed with any public funds. If the Applicant has no
                         previous experience, please include a signed letter from the consultant detailing their
                         experience in serving as a consultant in publically financed, affordable, rental housing. Also
                         please include a copy of the executed contract between the Applicant and the consultant.
                         Also attach the completed Property Management Experience Form (see Appendix K).



G.   Conflicts of        Submit as Exhibit 4, the Applicant organization's policy regarding conflicts of interest. This
     Interest            can be part of the applicant organization's Bylaws or can be a separate board statement.


                         Attach a list of all individuals associated with the Applicant or the ownership entity that have a
                         reportable financial interest in the project. Detail the type of participation in the project,
                         percentage, and dollar amount of financial interest in the project, including broker, contractor,
                         and other professional fees.




     2008 SHDP 400 Application Form                                                                                     Part B, Page 3
SECTION 2.                       PROJECT INFORMATION


Submit one completed copy of Section 2, with all required documentation, for each noncontiguous site requesting
Program funds.

                     New Construction                          Acquisition and Rehabilitation


                                                                        Substantial Rehabilitation


                                                                        Moderate Rehabilitation


A.   Address of Site



B.   Number of           Please enter the appropriate unit information.
     Units
                          Total Number of Units                Number Fully Accessible (Type A) Units


C.   Target              Preferences for persons with a specific disability are prohibited unless the project can justify
                         such a preference within the limits described in Part A, Occupancy Requirements (page A-7).
     Population
                         If the project is proposing such a preference, please attach as Exhibit 15 a narrative
                         describing the services that will being offered at the project and how your proposed
                         preference is in accordance within the following limits:
                          (a) the preference is limited to the population of households (including individuals) with
                         disabilities that significantly interfere with their ability to obtain and maintain themselves in
                         housing;
                         (b) who, without appropriate supportive services, will not be able to obtain or maintain
                         themselves in housing; and
                         (c) for whom such services cannot be provided in a non-segregated setting.


                                 Yes, the project is proposing a preference for:


                                 No preference is proposed


D.   Narrative           Briefly describe the project, who it will serve and the need it fulfills:
     Description         (This narrative may be used in press releases, public statements, etc.)




     Housing 400 Initiative
     SHDP 400 Application Form                                                                            Part B, Page 4
E.   Buildings and                                                             Gross Heated
     Site                                            Number of Units           Square Feet
                                   Building 1
                                   Building 2
                                   Building 3
                                   Building 4
                                   Building 5
                                   Building 6
                                    TOTAL
                                Total Square Footage of Site (land):                     square feet


F.   Housing Units         Describe the housing unit configuration of the proposed project:
                     (a)            (b)           (c)               (d)         (e)          (f)             (g)           (h)
Type of Unit      Number of Number of            Square       Number of        Kitchen    Furniture        Rent Paid     Utilities
                    Units   Households          Feet/Unit     Bathrooms/                                  by Resident    Paid by
                             Housed/                             Unit                                                    Resident
                               Unit
1-Bedroom
2-Bedroom
Total Units                 -
Will there be a manager's unit/bedroom?
                                                              Yes         No
G. Equipment                    Fire Sprinkler System                                    On-site Laundry Facilities
   Furnished                    Dishwasher                                               Range
                                Disposal                                                 Refrigerator
                                In-unit Washer/Dryer Hook up                             Other:


H.   Utilities             Heat:                        Gas Forced Air                   Other:
     Configuration                                      Electric Heat Pump

                           Hot Water:                   Gas                              Other:
                                                        Electric

                           Air Conditioning:            Central Air                      Window Units                   None


I.   Systems               Check the following existing systems that are adequate and available at the site:
                                Electric                                                 Storm Sewer
                                Natural Gas                                              Water (City)
                                Sanitary Sewer                                           Water (County)


J.   Environmental Check any of the boxes that describe the site:
                                Adjacent to major highway                                Historic/archeological significance
                                Has asbestos                                             In flood plain
                                Has hazardous waste                                      Near railroad/airport
                                Has lead-based paint


     2008 SHDP 400 Application Form                                                                                Part B, Page 5
K.   Access to           Describe proximity of the following services and facilities to the proposed project site. Also
                         state whether public transportation is available. Provide a map to the facility which indicates
     Services
                         the proximity of each service to the site as Exhibit 5 .



                                         Service/Facility                                  Proximity to Site

                         Supportive services including medical facilities


                         Employment Centers
                         Parks and Recreation
                         Schools
                         Shopping Facilities
                         Public Transportation


L.   Evidence of         Submit as Exhibit 6, a written statement on letterhead stationary from the unit of local
     Zoning              government in which the property is located indicating that the proposed use of the site is
                         permissible under applicable zoning ordinances or other appropriate land development
                         regulations.

M.   Site Control        Check the box that best describes the form of site control held at the time of application.
     and Value           Include a copy of the appropriate document as part of Exhibit 7 .


                              Deed or other proof of ownership                  Long-term lease (must be approved by Agency)
                              Executed Option to Purchase                       Other:

                         Does a direct or indirect identity of interest exist between the Applicant and the seller of the
                         property?

                              Yes                                               No
                         If yes, specify relationship:
                         A copy of an appraisal of the land for new development or land and building(s) for acquisition
                         and rehabilitation projects is required. The Agency strongly recommends that the Applicant
                         get an appraisal prior to securing site control to ensure a fair price. Include a copy of the
                         appraisal as part of Exhibit 7.


N.   Relocation          Attach as Exhibit 8 , a relocation plan providing the information listed below if proposed
                         project requires permanent or temporary relocation of individuals, households, or businesses
                         currently occupying the site. The Agency will not provide any funds for relocation benefits. If
                         the project does not require relocation, no attachment is necessary.

                         1.   The total number of units and the number of occupied units. Indicate whether the
                              occupied units are owner or renter units. Describe also nonresidential units in need of
                              relocation.

                         2.   The number of occupants to be permanently relocated, the number to be temporarily
                              relocated, the number that will remain, and the plan for relocating all affected occupants.


                         3.   The estimated cost of any planned relocation as well as the source of relocation funding,
                              and the agency or organization overseeing the relocation process.

                         4.   An explanation of any residential or nonresidential relocations from the site in the past year.

     2008 SHDP 400 Application Form                                                                         Part B, Page 6
O. Development          Project Coordinator:
   Team                 Name:                                  Phone:
                        Email:
                        Consultant:
                        Name:                                  Phone:
                        Email:
                        Construction Manager:
                        Name:                                  Phone:
                        Email:
                        Architect:
                        Name:                                  Phone:
                        Email:
                        Qualified Contractor:
                        Name:                                  Phone:
                        Email:
                        Energy Consultant:
                        Name:                                  Phone:
                        Email:
                        Other:
                        Name:                                  Phone:
                        Email:


SECTION 3.                  SUPPORTS and SERVICES

A. Targeting Plan       Attach as Exhibit 9 , a Letter of Commitment from the Local Lead Agency. See Appendix F
                        for required content, sample targeting plan and MOU.


B. Project              Identify the Partners in Project Operations:
   Operations           Owner:
                        Name:
                        Property Manager:
                        Name:
                        Lead Agency:
                        Name:

   If the same entity is performing the role of both Property Manager and Lead Agency, please provide a narrative
   explanation of how these roles will be separated to ensure compliance with Fair Housing law. Attach additional
   pages if necessary.




  Housing 400 Initiative
  SHDP 400 Application Form                                                                            Part B, Page 7
SECTION 4.                       OTHER PROJECT OR APPLICANT INFORMATION

A.   Community           Attach as Exhibit 10, Documentation of Community Needs and Priorities as evidenced by
     Need                either: 1) Certification of Consistency with the Consolidated Plan (form HUD-2991), or 2)
                         Letter of Consistency with Local Continuum of Care.




B.   Appeals to          If the property does not intend to utilize the NCHFA Model Lease, please attach as Exhibit
     Evictions and       11 , copies of leases and other documents that will be used outlining any contractual
                         agreements between the project and its residents. If the NCHFA Model Lease will be used,
     Termination of      please provide a statement to that effect.
     Services




C.   Organization        Attach as Exhibit 12 , a copy of the Applicant organization's most recent annual operating
     Budget              budget. This budget should include both expenses and the sources of funds to finance all
                         expenses during the budget year.

D.   Local                       Local political jurisdiction in which the project will be located:
     Government                  Name of City, Town, or County
                                 Name of Chief Administrative Official
                                 Address
                                 City                                                                 Zip Code
                                 Telephone                                           Fax




     Housing 400 Initiative
     SHDP 400 Application Form                                                                                   Part B, Page 8
SECTION 5.                       PROJECT DEVELOPMENT COSTS

As Exhibit 13 , attach the following information requested in this section for each building constructed or acquired using
Program funds.

1.   Provide (1) preliminary site plan, (2) building front elevation, (3) building side eleveation and (4) floor plan for typical
     floor(s).




     Proposals for renovation of structures must include a Physical Needs Assessment (PNA) with cost information, a
     hazard inspection, structural inspection, and a termite report. The hazard inspection should include, at a minimum,
     the identification of lead-based paint and asbestos in the building with a plan and budget for remediation. A PNA
     should be submitted to summarize the existing condition of all major systems in the building as well as fixtures,
     appliances, cabinetry, floor coverings, paint, and other items needed to ensure the building is up to local code
     standards; and must be completed by a third party licensed engineer or architect. Recommendations on
     replacement and repair should be provided. A scope of planned renovation work and costs, including major
     systems being replaced and major alterations in building design should be included. A sample PNA is available
     from the Agency upon request. In addition, please include an "as-rehabbed" appraisal according to the submitted
     work write-up as part of Exhibit 13. A missing or incomplete PNA or "as-rehabbed" appraisal is basis for denial.


2.   A description of the Applicant's procurement process for architect, contractor, construction manager, etc. for the
     construction of this project. Include requirements for qualification. Identify any Identity of Interest.

3.   Development timetable for project.




As Exhibit 14 , attach copies of all letters of commitment for permanent project development funding.




     2008 SHDP 400 Application Form                                                                             Part B, Page 9
SECTION 5.                    PROJECT DEVELOPMENT COSTS (continued)
Complete the following cost information as applicable to your project. Blue cells must have values entered.


A. USES OF FUNDS
                                                                                           COST TO        MAXIMUM
                                      COST ITEMS
                                                                                           PROJECT       ALLOWABLE
 1 Land
 2 On-Site Improvements
 3 Off-Site Improvements
 4 TOTAL IMPROVED LAND (lines 1 - 3)                                                   $             -
 5 Building Acquisition
 6 Rehabilitation Costs
 7 Demolition
 8 New Construction
 9 Construction Contingency
10 General Requirements (maximum 6% of line 6 or 8)                                                      $          -   0
11 Contractor Overhead and Profit (maximum 10% of lines 2 & 6 - 10)                                      $          -   0
12 Architect Design (maximum 5% of lines 2 & 6 - 10)                                                     $          -   0
13 Architect Inspection (maximum 1% of lines 2 & 6 - 10)                                                 $          -   0
14 Engineering Costs
15 TOTAL CONSTRUCTION COSTS (lines 5 - 14)                                             $             -
16 Construction Insurance
17 Construction Loan Origination Fee
18 Construction Loan Interest
19 Construction Loan Credit Enhancement
20 Water, Sewer and Impact Fees
21 Survey
22 Property Appraisal
23 Phase I Environmental Assessment
24 Bond Costs
25 Permanent Loan Origination Fee
26 Title and Recording
27 Advanced Energy Corporation - Energy Efficiency Consulation                         $        3,500    $          -
28 Cost Certification Fee
29 Other:
30 Real Estate Attorney
31 Other Legal Costs
32 TOTAL SOFT COSTS (lines 16 - 31)                                                    $             -
33 Developer's Fee (max 15% of lines 2 - 31, less lines 3, 5, & 11)                                      $        525   0
34 Consultant's Fee*                                                                                     $        245
35 TOTAL Dev & Consult fees (max 15% of lines 2 - 31, less lines 3, 5, & 10)           $             -
36 Furnishings and Equipment
37 Escrows
38 Operating Reserve (Minimum 6 months Operating Expenses)
39 Other:
40 TOTAL RESERVES & ESCROWS (lines 36 - 39)                                            $             -
41 TOTAL DEVELOPMENT COSTS (lines 4, 15, 32, 35, & 40)                                 $             -                  0


* The consultant fee alone should not exceed the greater of $30,000 or 7% of lines 2-31, less lines 3, 5, & 10.




    2008 SHDP 400 Application Form                                                                                      Part B, Page 10
B. SOURCES OF PERMANENT FUNDS
     Is the applicant interested in construction lending from NCHFA?
            Yes                                                    No


           Amount requested:                        $



Attach all letters of interest or commitment as Exhibit 14
                                                                                         Loan                                              Firm
                                                            Amount of       Interest                Amortizing        Repayment
                                                                                         Term                                          Commitment
                                                              Loan            Rate                   Period            Structure
                                                                                        (years)                                        (check if yes)

37 Bank loan:
38 SHDP 400                                                                 0.00%              30          360
39 Foundation or Private Contributions
40 Other:
41 Other:
42 Other:
43 TOTAL SOURCES (add lines 37-42; line 43 must equal
     line 36 on page 10, Total Development Costs)
                                                        $               -
$-
      $-
C. DEBT SERVICE
All Supportive Housing Development Program assistance will be in the form of principal only loans. No
interest will be charged. To complete this chart, refer to the information provided in the Sources of Permanent Funds
table (above). Include all other mortgage payments made on the property.



                                 (a)                                (b)                 (c)            (d)             (e)               (f)
                         Source of Financing                   Loan Amount        Interest Rate     Loan Term        Monthly       Annual Payment
                                                                                      (APR)          (months)        Payment          (c x 12)


44   SHDP 400                                                  $              -        0.00%               360

45                                                                                                                                 $                -

46                                                                                                                                 $                -

47                                                                                                                                 $                -

48                                                                                                                                 $                -

49                                                                                                                                 $                -

50   DEBT SERVICE TOTAL (add lines 44-50)                                                                        $             -   $                -




     Housing 400 Initiative
     SHDP 400 Application Form                                                                                                           Part B, Page 11
SECTION 6.                             PROJECT OPERATING PROFORMA
In this section, describe resident rents/fees, other project income, the supportive services budget, and the operating
budget as instructed in each subsection, and create a five-year cash flow for your project.

A. PROJECT OPERATING INCOME
                                    (a)                                              (b)                             (c)         (d)        Annual
                                                                                                                   Monthly             Income
                               Type of Income                                 Source of Income
                                                                                                                   Income              (c x 12)



1    Resident rents                                           Residents                                                          $              -

2    Key Program Operating Subsidy*                           NC-DHHS                                                            $              -
3    Project Based Rent Assistance                                                                                               $              -

4    Tenant Based Rent Assistance                                                                                                $              -

5    McKinney-Vento SHP Operating Subsidy**                   HUD                                                                $              -

6    Other:                                                                                                                      $              -

7    Other:                                                                                                                      $              -

8    OPERATING INCOME TOTAL (add lines 1-7)                                                                    $             -   $              -
9    PER UNIT OPERATING INCOME:



B. PROJECT OPERATING EXPENSES
                                   (a)                                                (b)                          (c)                 (d)
                           Operating Expenses                             Provider of Operating Item           Monthly Cost       Annual Cost
                                                                                                                                    (c x 12)


10   Administrative/Operations Staff                                                                                             $              -

11   Supplies                                                                                                                    $              -
12   Utilities paid by owner                                                                                                     $              -

13   Trash Removal                                                                                                               $              -

14   Repair/Maintenance                                                                                                          $              -
15   Property/Liability Insurance                                                                                                $              -

16   Grounds                                                                                                                     $              -

17   Other:                                                                                                                      $              -
18   Other:                                                                                                                      $              -

19   Other:                                                                                                                      $              -
20   Other:                                                                                                                      $              -

21   Replacement Reserves (Minimum of $250/unit/year)         Annual Minimum Amount:             $     1,000                     $              -

22   OPERATING EXPENSE TOTAL (add lines 9-20)                                                                  $             -   $              -
23   PER UNIT OPERATING EXPENSES (not including reserves) :



* Key Program Operating Subsidy from DHHS may only be used to fund property operating expenses and
may not be used to fund supportive services.




Housing 400 Initiative
SHDP 400 Application Form                                                                                             Part B, Page 12
SECTION 6.                            PROJECT OPERATING PROFORMA (CONTINUED)

E.   PROJECT CASH FLOW

The Agency will use a set of standard assumptions in analyzing project cash flow to determine financial viability of the
project. These should be used in completing Years 2-5 of the Project Cash Flow.


The Applicant must submit in writing justification for modifying any of the following assumptions:


CASH FLOW ASSUMPTIONS

Vacancy Rate (if project based rental assistance, change
to 5%)                                                      7.0%
Annual Increase of Rent                                     3.0%
Annual Increase of Operating Income                         3.0%
Annual Increase of Operating Expenses                       4.0%
Annual Operating Costs Per Unit Excluding Reserves         $4,521




PROJECT CASH FLOW (OPERATING)
Debt coverage ratio must be 1.15 or greater for the entire loan term.
     Cash Flow Item                                                     Year 1           Year 2           Year 3           Year 4           Year 5
40 Total Project Rental Income (Page 12. Lines 1- 3)                $            -   $            -   $            -   $            -   $            -
41 Operating Subsidy (Page 12, Lines 4-6)                           $            -   $            -   $            -   $            -   $            -
42 Vacancy Allowance (Line 40 * 7% or 5%)                           $            -   $            -   $            -   $            -   $            -
43 Operating Expense (Page 12, Line 21)                             $            -   $            -   $            -   $            -   $            -
44 Total Expenses (Lines 42+43)                                     $            -   $            -   $            -   $            -   $            -
45 Net Operating Income (Lines 40+41-44)                            $            -   $            -   $            -   $            -   $            -
46 Total Debt Service (Page 11, Line 50))                           $            -   $            -   $            -   $            -   $            -
47 Net Profit or Loss (Lines 45-46)                                 $            -   $            -   $            -   $            -   $            -
48 Debt Coverage Ratio (Lines 45/46)                                        -                -                -                -                -




     2008 SHDP 400 Application Form                                                                                            Part B, Page 13
SECTION 7.                      SIGNATURE OF AUTHORIZED OFFICIAL

1.    By signing below, the Applicant certifies that the information provided in this application is true and complete.


2.    By signing below, the Applicant agrees that the Agency may conduct its own independent review of the
      information herein and the attachments, and may verify information from any source.

3.    All applications submitted become the property of the Agency.


4.    Submission of an application does not guarantee funding. Any costs incurred prior to the issuance of a firm
      commitment letter by the Agency are the sole responsibility of the applicant.




By:
                                                   Signature of Authorized Official


Name:


Title:


Date:




2008 SHDP 400 Application Form                                                                           Part B, Page 14

								
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