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					                                      COUNTY OF SAN MATEO
                                       Housing Development
                                Application, Instructions and Checklist
                                              FY 2011-12
Applicant:
Project/Program:
Total Amount of Request:

To be accepted, your application must contain the following: this application form and all of
the requested attachments. Each attachment must be identified by Attachment Number
and Title in the upper right hand corner of the page. If the attachment involves multiple
pages, you must put the attachment number and title on a separate divider page in front of
the actual attachment pages. If a particular attachment is not available, not applicable, or
the information is contained in one of the other attachments, you still must provide a
separate place-holder page with the attachment number and title and indicate the status
of that attachment. All attachments must be placed behind the application in numerical
order. The entire application should be clipped together; do not use staples. In addition,
you must attach one set of the appropriate organizational documents to the back of the
original application packet. Each document must be identified in the same manner as the
application attachments.

Application Checklist: (Original plus 12 collated copies)
    Application                                             Attachment 9 – Appraisal (Acquisition Only)
    Attachment 1 – Project Team                             Attachment 10 – Project Timeline
    Attachment 2 – Dev. Budget & Narrative                  Attachment 11 – Relocation Plan
    Attachment 3 – Other Funds                              Attachment 12 – Marketing Plan
                                                            Attachment 13 – Hazardous Materials
     Attachment 4 – Operating Budget & Narrative
                                                            Mitigation
     Attachment 5 – Construction Estimate                   Attachment 14 – Property Management

     Attachment 6 – Area Map/Site Photo/Site Plan           Attachment 15 – Community Notification

     Attachment 7 – Evidence of Site Control                Attachment 16 – Local Match
     Attachment 8 – Title Report

Organizational Documents Checklist: Please select from one of the two organization types and only
submit required attachments from that section. (1 Copy of the Organizational Documents Only)
      Non-Profit Organization                              Public Agency
      Attachment 17 - Resolution                           Attachment 17 - Resolution
      Attachment 18 - Board Roster                         Attachment 18 - Audit
      Attachment 19 - Board Dates                          Attachment 19 - Single Audit
      Attachment 20 - Audit                                Attachment 20 - Certification Letter
      Attachment 21 - Single Audit
      Attachment 22 - Certification Letter
      Attachment 23 - Proof of non-profit status
      Attachment 24 - Corporate By-Laws
      Attachment 25 - Articles Of Incorporation



NOFA FY 2010-11 Housing Development Application
                          County of San Mateo - Department of Housing
                                Application for Funds FY 2011-12
                                         CDBG/HOME
                                                  HOUSING DEVELOPMENT

Project Title :
Project Locations/Address/Zip:
Project Summary
(please provide 1-2 sentences describing the
project you are applying for:
Property APN #:

Total Amount Requested under this NOFA:                  $                   Total Project Cost:   $
Previously Approved County             $                        Source:                    FY:
   Funding For This Project            $                        Source:                    FY:
                                       $                        Source:                    FY:
                                       $                        Source:                    FY:
                                       $                        Source:                    FY:

Type of Project:                           New Construction
                                           Conversions of Non-Housing Structure to Housing
                                           Acquisition Only- NO Rehabilitation Required
                                           Acquisition & Rehabilitation
                                           Rehabilitation Only- NO Acquisition required


Applicant Name:
Address:                                                                                   ZIP:
Mailing Address (if different):
Telephone:                                              Fax :                        Tax ID #:
Contact Person:                                                     Title:
Telephone:                                    E-Mail:
Name of Agency Director:
(if different from Contact)
Name & Title of Person Authorized to Execute Legal Documents
with County for this Project (Should match attachment 16):

Type of Housing        Single Family Rental                  Owner Occupied        Number of Units:
                       Multi-Family  Rental                  Owner Occupied        Number of Units:
                       Group Home/SRO:                                                    Number of
                                                                                          Beds/Units:
   Total Units in Project:                                          Total Affordable Units in Project:
            NOTE:                       Number of “Extremely Low Income” households to be served:
   The four lower income                   Number of “Very Low Income” Households to be served:
  categories should equal                 Number of “HOME Income Limit” Households to be served:
 the Total Affordable Units                     Number of “Low Income” Households to be served:

NOFA FY 2011-12 Housing Development Application
Relocation. Are there any                         Yes         You should consult with the DOH Staff regarding
residential tenants or businesses                 No          anticipated or potential relocation issues. Be
occupying any part of the                                     prepared to revise or adjust your budget
property? See Question #14.                                   accordingly.

1. Project Summary:

     a.Provide a narrative summary of the project. Include current condition of the parcel and/or if
        any homes or facilities are currently on the parcel.

     b.Project specific objectives:

     c. Target population; number and percentage of units serving indicated populations:

     d.Please describe any supportive services associated with the project:

     e. Geographic impact:

     f. Description of exact scope of services for which you plan to use funds:

     g.Proposed term of affordability and any affordability restrictions imposed by other funding
       sources, if applicable.


2. Project History: Please briefly describe the project’s history leading to this request. Include such
   information as when the site was acquired or will be acquired, if rehabilitating an existing structure
   include year that it was built, any previous requests for County funding, changes in the project
   since those requests were made, attempts made to secure other financing, how current project
   was estimated, and any other relevant information about the history of the project.



3. Identification of Priorities: How did you determine the needs for your Project? Identify the specific
   NOFA Objectives from Section II of the Funding Guidelines that your program/project meets.



4. Organizational Mission: Describe your overall organizational mission.



5. Project Details: Do you have all necessary planning approvals? List all approvals required for your
   project and indicate the status and actual or projected approval dates. You may refer to timeline
   (Attachment 10) for details on project milestones.



6. Does your project require licensing?                 Yes   No

    If so, what is the status of the license?



NOFA FY 2011-12 Housing Development Application
7. Are plans and specifications completed?     Yes   No
   If “No”, when do you anticipate completion? You may refer to timeline (Attachment 10) for
   details on project milestones.




8. Specify in detail how your project addresses other issues relating to housing, such as proximity to
   public transit, shopping, neighborhood revitalization, etc.




9. Specify in detail any physical or programmatic amenities proposed as a part of your project, such
   as on-site child care, work skills training, life skills training, etc.



10. Specify how you intend to incorporate Green Building methodology to your program. (See
    Section V.S of Funding Guidelines).



11. Specify any other project issues that you feel should be considered in review of this application for
funds.



12. Accessibility: Describe the accessibility of your proposed project including the number of units to
    be made accessible and the extent of that accessibility.



12a. Complete the chart below for the proposed project upon completion.
Unit Accessibility Type                        Current #     % of Total         Proposed      % of Total
                                                                                    #
                         Currently Accessible:
               Can be Adapted for Accessibility:
                  Non-accessible or adaptable:
                                       TOTAL:

13. Collaboration: Describe how your agency collaborates with other service providers to meet the
    various needs of your clientele.




NOFA FY 2011-12 Housing Development Application
14. Relocation: If your project is expected to incur a relocation obligation, briefly explain the nature of
    the relocation: e.g. who is to be relocated; whether permanent of temporary; estimated cost per
    household/business; timeline, etc. (Include Relocation Plan if it is already completed or an
    estimated timeline when the Plan will be submitted)



15. CHDO: Are you a CHDO (Community Housing Development Organization)?               Yes    No
    If yes, please complete the CHDO Certification Form and include it and all required attachments
    as a part of the application packet. See Program Guidelines Exhibit 7.

                                    Please tab to next page for authorization form.




NOFA FY 2011-12 Housing Development Application
                                            APPLICATION AUTHORIZATION

This application was prepared by:

Name                                                        Title




Signature                                                   Date

This application is submitted by:

I/We certify that the information and statements submitted in and attached to this application, are
true, accurate and complete to the best of my/our knowledge. I/We authorize the Department of
Housing to verify any information pertaining to this application. I/We acknowledge and understand
that if facts and/or information herein are found to be misrepresented, it may constitute grounds for
rejection of the application or default of the allocation for which this application is being made.


Name                                                        Title




Signature                                                   Date




Name                                                        Title




Signature                                                   Date




                               Please tab to next page for list of required attachments.




NOFA FY 2011-12 Housing Development Application
ATTACHMENTS:      The following questions should be addressed on separate pages as Attachments.
Each attachment must be labeled with Attachment # and Title in the upper right hand corner. If the
Attachment contains multiple pages, you should include a separate divider page labeled
appropriately. If the information requested is not applicable to your project, is not available, or is
included as a part of another attachment, insert a place holder page appropriately labeled and so
indicate.

ATTACHMENT 1 - PROJECT TEAM - Specify the names, experience, responsibilities and roles of each
team member. Indicate whether they are full-time or part-time employees.

ATTACHMENT 2 - DEVELOPMENT BUDGET/NARRATIVE - The total cost of your project must be shown on
the Sources and Uses Schedule. Please indicate all anticipated sources and uses of funding in
addition to County funds. Please distinguish County funds by funding source. Provide a narrative
explanation of each line item (Exhibit 2 of the Funding Guidelines shows a sample budget).

ATTACHMENT 3 - OTHER FUNDS - For all other funding sources, attach documentation of funding
commitments. Indicate the status of funding requests if you do not have firm commitments.

ATTACHMENT 4 - OPERATING BUDGET/NARRATIVE - Provide income and expense projections for at
least the first 10 years of operations after completion of your proposed project. Indicate proposed
rent schedule (including utility allowances) for all units. If operating income is from other than user
rents, please explain anticipated source(s) of income for on-going operation and maintenance.
Specify any assumptions you have made in creating these projections (Exhibit 3 of the Funding
Guidelines shows a sample operating budget). Provide income breakdown by unit size, rent and
income targeting.

ATTACHMENT 5 - CONSTRUCTION ESTIMATE - Provide copies of any construction bids/estimates
(minimum two). If bids are not available, please explain how you arrived at estimated construction
costs.

ATTACHMENT 6 - AREA MAP/SITE PHOTO/SITE PLAN - Provide an area map indicating location of the
project, and a photograph of the project site, along with site plan.

ATTACHMENT 7 - EVIDENCE OF SITE CONTROL - Provide evidence of site control (e.g. grant deed, sales
agreement, option agreement, lease agreement, etc.) showing that you have or will have the
authority to carry out the proposed project. If you do not currently have site control, submit a
narrative explanation.

ATTACHMENT 8 - TITLE REPORT - Please provide a copy of the most recent (issued within the past 6
months) title policy or title report.

ATTACHMENT 9 – APPRAISAL - If your project involves acquisition, even if you are not intending to use
County funds for this purpose, please provide a copy of the appraisal. If you do not yet have an
appraisal, please indicate when you expect to obtain one. The County reserves the right to request
an appraisal for all projects as determined by the staff.

ATTACHMENT 10 - PROJECT TIMELINE - Provide a project schedule, designating specific work tasks,
projected delays, accomplishments, escrow dates, construction start dates and major milestones.
Please indicate any specific dates or requirements for which the County funds will impact other
funding sources or deadlines.

ATTACHMENT 11 - RELOCATION PLAN - Provide a copy of the written relocation plan if applicable. If
the proposed project will involve relocation and you do not yet have a relocation plan, please
indicate when you expect to provide one to DOH staff.


NOFA FY 2011-12 Housing Development Application
ATTACHMENT 12 - MARKETING PLAN Provide a copy of the marketing plan for the proposed project
which describes the techniques, practices and procedures for marketing.

ATTACHMENT 13 - HAZARDOUS MATERIALS MITIGATION If a hazardous materials assessment has already
been created on the proposed project, please submit a copy. Describe how you plan to address any
findings of hazardous materials (e.g. lead, asbestos, mold) in your project. (See Housing Guidelines Section
V. F & L for further information.) The County reserves the right to request a Hazardous Materials Assessment.

ATTACHMENT 14 - PROPERTY MANAGEMENT Who will be responsible for on-going maintenance and
operations of the development. Indicate Name, Address & Phone Number.

ATTACHMENT 15 - COMMUNITY NOTIFICATION You must notify the respective city or town that your project
is proposed to be located in through the office of the City or Town Manager. Please provide evidence of
this contact and any acknowledgement by the city or town.

ATTACHMENT 16 – LOCAL MATCH Provide a table of the proposed 25% Local Match with non-federal forms
of subsidy. (See section IV. B of the Housing Development Guidelines)

Please select from one of the two organization types and only submit required attachments from that section:
   NON-PROFIT ORGANIZATION                                PUBLIC AGENCY

   ATTACHMENT 17 - RESOLUTION from your Board             ATTACHMENT 17 - RESOLUTION from your City
of Directors authorizing submission of this            Council or governing body authorizing submission
application. The resolution should also authorize a    of this application, and designating a contact
specific person, by name or title, responsible for     person.
executing all documents in support of the funding
request.                                                    ATTACHMENT 18 - AUDIT Copy of the most
                                                       recent financial audit or your organization,
   ATTACHMENT 18 - BOARD ROSTER of your Board          including any management letters. . If the audit
of Directors                                           provided covers a period prior to FY 2008-09 and
                                                       your program/project is selected for funding, you
  ATTACHMENT 19 - BOARD DATES on which your            will need to provide the FY 2008-09 audit prior to
Board met during the past 12 months                    release of any County funds. Once your 2009-10
                                                       audit is available, that should also be sent to
    ATTACHMENT 20 - AUDIT Copy of the most             County HCD staff.
recent financial audit or your organization,
including any management letters.                         ATTACHMENT 19 - SINGLE AUDIT Please note if
                                                       audit includes the A133 single audit requirement if
   ATTACHMENT 21 - SINGLE AUDIT Please note if         your organization expended more than $500,000 in
audit includes the A-122 and A-133 single audit        federal funding from any sources.
requirement if your organization expended more
than $500,000 in federal funding from any sources.        ATTACHMENT 20 - CERTIFICATION LETTER If your
                                                       organization did not expend $500,000 or more of
    ATTACHMENT 22 - CERTIFICATION LETTER If your       federal funds from any source in the year of the
organization did not expend $500,000 or more of        audit, you must attach a certification indicating this
federal funds from any source in the year of the       fact. (See Exhibit 5 of Program Guidelines for
audit, you must attach a certification indicating      sample letter).
this fact. (See Exhibit 5 of Program Guidelines)

   ATTACHMENT 23 - PROOF OF NON-PROFIT
STATUS (501(c)(3) designation)

   ATTACHMENT 24 - CORPORATE BY-LAWS

   ATTACHMENT 25 - ARTICLES OF INCORPORATION


NOFA FY 2011-12 Housing Development Application

				
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