"Private Label Resale Rights Agreement"
• CHFA & DECD CONSOLIDATED APPLICATION FORM Submission Date: Homeownership, Community Impact and Certifications Applicant Name Development Name SECTION VI. HOMEOWNERSHIP DEVELOPMENTS 6.1 Homeownership Unit Descriptions (DECD only) Please provide detailed information on each unit including income targets, utilities, energy sources and amenities. If subsidies are projected they must also be provided. Attach and label as "Exhibit 6.1" 6.2 Homeownership Sales Proceeds Please complete provided form. Attach and label as "Exhibit 6.2" 6.3 Supplementary Information (DECD only) Please provide and attach: 6.3.a. For Homeownership developments, what mechanism for Affordability will be used? Resale Restriction Subsidy Recapture Provide a sample of the document(s) to be used. Attach and label as “Exhibit 6.3.a” 6.3.b. Homeownership – Developer/Homebuyer Subsidy Determination Worksheet. Attach and label as "Exhibit 6.3.b" 6.3.c. Development Cash Flow Analysis for Single Family Housing. Attach and label as "Exhibit 6.3.c" 6.3.d. Plain language explanation of resale/recapture provision. Attach and label as "Exhibit 6.3.d" 6.3.e. Homebuyer Training Plan. Attach and label as “Exhibit 6.3.e” 6.4 Documentation of Property Taxes and Insurance (HTCC Only) Attach and label as "Exhibit 6.4" SECTION VII. COMMUNITY IMPACT 7.1 Length of Affordability How many years will the development remain affordable? 5 years 10 years 15 years 20 years 30 years Other (describe) 7.2 Income Group Targeting Units Targeted to Extremely Low (25% AMI) and Very Low (50% AMI) Households Income Group Rental Units Homeowner Units Served Number % of Total Number % of Total 0-25% AMI 0.00% 0.00% 26-50% AMI 0.00% 0.00% 51-60% AMI 0.00% 0.00% 61-80% AMI 0.00% 0.00% 81-100% AMI 0.00% 0.00% 101-120% AMI 0.00% 0.00% > 120% AMI 0.00% 0.00% TOTAL 0 0 7.3 Community Stability Describe the development’s activities that are designed to increase community stability. Such activities may include strategies to increase and improve the elements that affect the structure of the community. Attach and label as “Exhibit 7.3” 7.4 Community Impact 7.4 a. Create a “snap shot” of the development to illustrate the way in which the development fits into the surrounding neighborhood and how it will impact the area. Attach and label as “Exhibit 7.4 a” 7.4.b. Targeting Commitments or Requirements Does this development include any other targeting commitments or requirements for other funders or investors? Yes No If "Yes", describe and attach and label as “Exhibit 7.4.b” C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Application 1 of 35 • CHFA & DECD CONSOLIDATED APPLICATION FORM Submission Date: Homeownership, Community Impact and Certifications Population Groups Rental Units Homeowner Units Served Number % of Total Number % of Total Family #DIV/0! #DIV/0! Disabled/Special #DIV/0! #DIV/0! Needs Elderly #DIV/0! #DIV/0! Homeless #DIV/0! #DIV/0! TOTAL 0 0 7.5 Resident Participation/Empowerment Please describe how this development will promote resident participation including the promotion of community members’ ability to contribute to their own well-being and that of their families and community. Attach and label as “Exhibit 7.5” 7.6 Community Support Include a narrative describing the extent to which the development demonstrates support by local/state government, community organizations, or individuals, other than as development sponsors. Also include copies of any letters of support received for the proposed development or program. Attach narrative and letters of support and label as “Exhibit 7.6” 7.7 Relocation Will the development require relocation of households or businesses? Yes No 7.7.a. If the Applicant and Co-Sponsor anticipates relocation or is unsure of whether relocation will occur, then the Applicant and Co- Sponsor must complete the Relocation Assistance Plan Guideform. Attach and label as "Exhibit 7.7.a" 7.7.b. Non-Displacement Certification If the development will not require relocation of households or businesses because it will be located on vacant or undeveloped property, or if the rehabilitation plan does not require relocation, then please submit the Housing and Urban Development (HUD) “Certification of Non-Displacement." Attach and label as "Exhibit 7.7.b" 7.8 Relocation Plan Please provide the Applicant’s and Co-Sponsor’s relocation plan, tenant list and copies of General Information Notices (GINs). Identify the number of households or businesses that may be displaced, if any. Disclose and quantify temporary and permanent relocations (residential and non-residential) needed to complete the development. If no relocation is required, this section is not applicable. Attach and label as “Exhibit 7.8” CGS 8-37z requires that State funded projects reduce or eliminate the displacement of households to the greatest extent possible. Any displacement must be the minimum amount necessary due to the nature of the project. Any proposals which include the displacement of units must contact DECD prior to the submission of an application to determine the procedures necessary to meet this mandatory requirement. 7.9 Relocation Schedule and Costs Complete the following chart. Estimated Estimated Relocation Start Relocation Type Number Date Completion Date Estimated Costs Displaced Households Displaced Businesses (or Farms) C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Application 2 of 35 • CHFA & DECD CONSOLIDATED APPLICATION FORM Submission Date: Homeownership, Community Impact and Certifications SECTION VIII. AFFIRMATIVE ACTION/FAIR HOUSING AND EQUAL OPPORTUNITY 8.1 Fair Housing For CHFA , please provide a copy of the Applicant and Co-Sponsor’s Fair Housing Action Plan which includes: 8.1.a. Fair Housing Policy Statement. Attach and label as "Exhibit 8.1.a" 8.1.b. Fair Housing Law Violations form provided. (Next Steps and LIHTC only) Attach and label as "Exhibit 8.1.b" For DECD, a Fair Housing Action Plan must be submitted which includes the following documents. The guideforms for these documents are located on the DECD Consolidated Application webpage. Attach and label this plan as "Exhibit 8.1.c." Fair Housing Action Plan Guideform AA5 Affirmative Fair Housing Marketing Plan (form provided) Tenant Selection Methodology (see also section 9 of the AA5) Fair Housing Policy Statement Discrimination Complaint Procedure Certification to Affirmatively Further Fair Housing Fair Housing Activity - Provide a written description identifying any developments, initiatives, or actions taken in the past 2 years by the Applicant and co-sponsor to promote the principles of fair housing. 8.1.d. Fair Housing Impact - Using the form provided, please identify how the proposed activity addresses and impacts the fair housing, diversity, and economic integration questions identified. Attach and label as "Exhibit 8.1.d" 8.2 Affirmative Action Plan Please provide Affirmative Action Policy Statements for all Applicants and Co-sponsors. For CHFA only , provide a copy of the Contractor's Affirmative Action Plan. Attach and label as “Exhibit 8.2” 8.3 Hiring and Contracting (DECD only) 8.3.a. Provide a copy of transmittal letter of contractor’s Affirmative Action Plan to Commission on Human Rights and Opportunities. . Attach and label as “Exhibit 8.3.a” 8.3.b. Attach Section 3 Plan. Attach and label as “Exhibit 8.3.b” 8.3.c. Describe and document past efforts to comply with the hiring and contracting requirements of Section 3 of the Housing and Urban Development Act of 1968 as amended. Please give specific examples. (HOME Only ) Attach and label as “Exhibit 8.3.c” 8.4 Americans with Disabilities Act/ Section 504 (DECD only) Provide an ADA notice and ADA Grievance Procedure. Attach and label as “Exhibit 8.4” C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Application 3 of 35 • CHFA & DECD CONSOLIDATED APPLICATION FORM Submission Date: Homeownership, Community Impact and Certifications SECTION IX. CERTIFICATIONS Certifications 9.1 Applicant Disclosure 9.1.a State Contracts. Does the funding recipient employ or contract with (1) any elected public official or the spouse of any elected public official or (2) any state employee or the spouse of any state employee who has supervisory or appointing authority over the state agency administering this funding? Yes No If "Yes", describe. Attach and label as "Exhibit 9.1.a" 9.1.b Campaign Contributions. Notice to executive branch state contractors and prospective state contractors of campaign contribution and solicitation ban. Read and complete form SEEC 10. Attach and label as "Exhibit 9.1.b" 9.2 Owner’s Affidavit Complete the Owner’s Affidavit provided regarding the Applicant’s and/or Co-Sponsor’s financial interest in each property. Attach and label as "Exhibit 9.2" 9.3 Previous Participation Complete the Previous Participation Certification form provided. Attach and label as "Exhibit 9.3" Litigation 9.4 Is the Applicant, Co-Sponsor, or any member of the proposed development team currently involved in any If "Yes", describe and attach and label as "Exhibit 9.4" Yes No 9.5 Has any state agency and/or the federal government taken any action against the Applicant and/or Co-Sponsor or If "Yes", describe briefly. Please attach and label as "Exhibit 9.5" Yes No 9.6 Has the Applicant, Co-Sponsor, or any member of the development team been convicted of a felony? If "Yes", describe briefly. Please attach and label as "Exhibit 9.6" Yes No Compliance 9.7 The Applicant and Co-Sponsor will describe all instances of default and/or debarment, both past and current, with CHFA, DECD,yes any branch of the State or Federal Government. Please check or or no for each question: 9.7.a The Applicant and Co-Sponsor are eligible as defined by State Statute or HUD Program Regulations. Yes No 9.7.b The requested activity is eligible under the appropriate State or Federal Acts. Yes No 9.7.c The Applicant and Co-Sponsor will maintain compliance with all program requirements. Yes No 9.7.d The Applicant and Co-Sponsor is in compliance with all existing DECD and HUD Assistance Yes No Agreements and CHFA Mortgage documents. 9.7.e The Applicant and Co-Sponsor have identified how the development meets and is consistent with the Yes No goal/strategy (ies) of State Statute, the DECD Consolidated Plan (Action Plan), the State Plan of Conservation and Development, and/or the State Long Range Housing Plan. 9.7.f The Applicant and Co-Sponsor certifies that they will demonstrate their compliance with Fair Housing Yes No Guidelines to the satisfaction of DECD and CHFA. 9.7.g The Applicant and Co-Sponsor certifies that they are aware of the conditions of the Fair Housing Yes No Action Plan and that they will meet the requirements as applicable in the Plan including, but not limited to, the Analysis of Impediments to Fair Housing. 9.7.h The Applicant and Co-Sponsor will promptly furnish any information and documentation requested by Yes No DECD or CHFA. DECD or CHFA may require changes in the information submitted herewith which are deemed reasonable. **If any of the above boxes are checked “No,” describe. Attach and label as “Exhibit 9.7” C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Application 4 of 35 • CHFA & DECD CONSOLIDATED APPLICATION FORM Submission Date: Homeownership, Community Impact and Certifications 9.8 Transfer Site Assessment (TASA) (LIHTC and Next Steps only) Applicant's certification that a Transfer Site Assessment (TASA) will be conducted. Attach and label as “Exhibit 9.8” 9.9 Fire and Safety Certification Applicant's certification of complicity with all applicable federal, state and local building, fire and safety codes, asbestos removal and hazardous waste regulation. Attach and label as “Exhibit 9.9” 9.10 Request For Release From Connecticut State Housing Program (LIHTC only) Attach and label as “Exhibit 9.10” 9.11 Certification For Rehabilitation of State Housing Authority Units (LIHTC only) Attach and label as “Exhibit 9.11” 9.12 Federal Environmental Reviews (HOME only) Activities involving federal funding are required to undergo an Environmental Review in accordance with the National Environmental Policy Act (NEPA) and Federal Regulations under 24 CFR Part 58. 9.12.a Please submit a NEPA Statutory Checklist and attach and label as Exhibit "9.12.a" 9.12.b. Please submit the NEPA Environmental Assessment Checklist and attach and label as "Exhibit 9.12.b" SECTION X. OTHER 10.1 10-Year Rule Waiver (LIHTC only) If applying for acquisition credits and a waiver of the 10-year ownership rule is necessary, provide a letter from the appropriate federal official that states that the project qualifies for a waiver under IRC Section 42(d)(6). 10.2 Application Fee (CHFA only) The undersigned understands that he/she may be prosecuted for false statement under the laws of the State of Connecticut under Section 53a-157 of the General Statutes, as amended from time to time, for any false statement made herein; and, the undersigned has been duly authorized to submit the attached in its name. It is hereby represented by the undersigned as an inducement to the Department of Economic and Community Development and the Connecticut Housing Finance Authority to consider the financial assistance requested herein, that to the best of my knowledge and belief no information or data contained in this application or in the attachments are in any way false or incorrect and that no material information has been omitted. The undersigned understands that the Department of Economic and Community Development and/or Connecticut Housing Finance Authority will rely on the information in this application and that, if the application is approved, any deliberate omissions, misrepresentations and/or incorrect statements in this application may result in withdrawal of the application from the review process at the Department of Economic and Community Development’s and/or Connecticut Housing Finance Authority’s discretion. The undersigned agrees that banks, credit agencies, the Connecticut Department of Labor, the Connecticut Department of Revenue Services, the Connecticut Department of Environmental Protection, and other references are hereby authorized now, or anytime in the future, to give the Department of Economic and Community Development and the Connecticut Housing Finance Authority any and all information in connection with matters referred to in this application, including information concerning the payment of taxes by the Applicant and Co-Sponsor. In addition, the undersigned agrees that the funds that may be provided pursuant to this application be utilized exclusively for the purposes represented in this application, as may be amended. Applicant Signature Date C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Application 5 of 35 • CHFA & DECD CONSOLIDATED APPLICATION FORM Submission Date: Homeownership, Community Impact and Certifications Co-Sponsor Signature Date The undersigned understands that he/she may be prosecuted for false statement under the laws of the State of Connecticut under Section 53a- 157 of the General Statutes, as amended from time to time, for any false statement made herein; and, the undersigned has been duly authorized to submit the attached in its name. C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Application 6 of 35 • EXHIBIT CHECKLIST Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 = Not applicable N = Non-Threshold Item - if applicable, required prior to approval. If available, include with application. T = Threshold Item - if applicable, required at application submission Check if submitted or Mark N/A THIS FORM MUST BE SUBMITTED WITH INITIAL APPLICATION & ALL RESUBMISSIONS CHFA/ DECD use DECD Funding CHFA Funding only Next Exhibit Program Project Financing LIHTC HTCC Steps Number SECTION VI. HOMEOWNERSHIP DEVELOPMENTS (N/A for Rental Properties) T 6.1 Homeownership Unit Descriptions (Form Provided) T T 6.2 Homeownership Sales Proceeds (Form Provided) T T 6.3.a Mechanism of Affordability T 6.3.b Developer/Homebuyer Subsidy Determination Worksheet (Form Provided) T 6.3.c Development Cash Flow Analysis for Single Family Housing (Form Provided) T 6.3.d Explanation of Resale / Recapture T 6.3.e Homebuyer Training Plan T 6.4 Documentation of Property Taxes and Insurance SECTION VII. COMMUNITY IMPACT T T 7.3 Community Stability T T N N 7.4.a Community Impact "Snapshot" O T N N 7.4.b Targeting Commitments or Requirements O T 7.5 Resident Participation/Empowerment N N N N N 7.6 Community Support T T T T T T 7.7.a. Relocation Assistance Plan Guide (Form Provided) T T N N T T 7.7.b. Non-Displacement Certification (Form Provided) T T N T T 7.8 Relocation Plan SECTION VIII. AFFIRMATIVE ACTION/FAIR HOUSING & EQUAL OPPORTUNITY T T T T 8.1.a Fair Housing Policy Statement T T 8.1.b Fair Housing Law Violations (Form Provided) T T 8.1.c Tenant Selection Methodology T T 8.1.d Fair Housing Impacts (Form Provided) T T 8.1.e Affirmative Fair Housing Marketing Plan (Form Provided) T T 8.1.f Discrimination Complaint Procedure T T 8.1.g Certification to Affirmatively Further Fair Housing T T N N T T 8.2 Affirmative Action Plan T T 8.3.a Section 3 Plan (HOME only) T T 8.3.b Section 3 Activity (HOME only) T T 8.4 Americans with Disabilities Act/Section 504 Notice SECTION IX. CERTIFICATIONS T T N N 9.1.a State Contracts T T T T T T 9.1.b SEEC 10 (Form Provided) T T T N 9.2 Owner's Affidavit (Form Provided) T T T N N 9.3 Previous Participation Certification (Form Provided) T T N N 9.4 Litigation Information T T N N 9.5 Description of Federal or State Action T T N N 9.6 Description of Felony Conviction T T N N 9.7 Compliance T T 9.8 Transfer Site Assessment (TASA) T T 9.9 Fire and Safety Certification T 9.10 Request For Release From Connecticut State Housing Program T 9.11 Certification For Rehabilitation of State Housing Authority Units T T 9.12.a NEPA Statutory Checklist (HOME Only) (Form Provided) T T 9.12.b NEPA Environmental Assessment (HOME Only) (Form Provided) SECTION X. OTHER T T 10.1 10-Year Rule Waiver T T T T 10.2 Application Fee C:\Docstoc\Working\pdf\File \ Exhibit Checklist 7 of 35 • Exhibit 6.1 - HOMEOWNERSHIP UNIT DESCRIPTIONS Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 House Style Expandability Model (e.g., Number Sq. Footage of Number of Number Lot Size Potential (Sq. Energy Utilities Sales Price By Type of Unit* Ranch, Cape) of Units Unit Size Bedrooms of Baths (Sq. Foot) Foot) Efficient Cost Model * Designate each unit as one or more of the following: MR: Market, HA: HOME Assisted, Other (Please Identify) Identify any energy efficient program Identify the Amenities that are included: Energy Efficiency Range Yes No Program Refrigerator Yes No Complete the following chart: Dishwasher Yes No Utilities Energy Source Garbage Disposal Yes No Heating Garage Yes No Hot Water Porch/Deck Yes No Cooking Basement Yes No Other: Other: C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ HO Unit Descriptions 8 of 35 • Exhibit 6.2 - HOMEOWNERSHIP SALES PROCEEDS Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 SALES PROCEEDS HUD Metropolitan Area 0 HUD Area Median Income Sales Proceeds from Land Sales Proceeds - Single Family Houses $0 Number of Single Family Houses 0 Sales Proceeds - Multifamily Houses $0 Number of Multifamily Homeownership Houses 0 Multifamily Homeownership Sales Proceeds $0 Number of Rental Units in Multifamily Houses 0 Rental Income Expected for Multifamily Homeowner $0 SINGLEFAMILY HOMEOWNERSHIP UNITS ALLOWABLE CHFA SALES TARGET MONTHLY COST PROPOSED IS PROPOSED EXPECTED YEAR NUMBER OF NUMBER OF PRICE LIMIT HOMEOWNER (trended to SALE PRICE of SALE PRICE OF SALE HOUSES BEDROOMS (Enter N/A if AMI % Expected Year of UNIT ALLOWABLE? DECD only) Sale) 1 $0 N/A 2 $0 N/A 3 $0 N/A 4 $0 N/A 5 $0 N/A ESTIMATED PROPOSED ARE PROPOSED ESTIMATED ESTIMATED FIRST MONTHLY 1st AND 2nd CASH DOWNPAYMENT MONTHLY MONTLY MONTHLY MORTGAGE COST (trended MORTGAGE DOWNPAYMENT ASSISTANCE TAXES INSURANCE CONDO FEES LOAN to Expected AMOUNTS AMOUNT LOAN AMOUNT* AMOUNT* Year of Sale)* ALLOWABLE? 1 $0 $0 N/A 2 $0 $0 N/A 3 $0 $0 N/A 4 $0 $0 N/A 5 $0 $0 N/A * Downpayment Assistance Loan and First Mortgage Loan are estimated at 5.5% interest rate and 30 year term. Montly taxes, insurance and condo fees are trended 3% annually to expected year of sale. Monthly utilities are trended annually at 5% to expected year of sale. OWNER OCCUPIED MULTIFAMILY HOMEOWNERSHIP UNITS ALLOWABLE MONTHLY ESTIMATED NUMBER OF ESTIMATED ESTIMATED TARGET COST FOR DOWN- PROPOSED EXPECTED YEAR BEDROOMS IN CASH DOWN- FIRST HOMEOWNER HOMEOWNER PAYMENT SALE PRICE of OF SALE HOMEOWNER PAYMENT MORTGAGE AMI % (trended to ASSISTANCE HOUSE UNIT AMOUNT LOAN AMOUNT* Expected Year of LOAN AMOUNT* Sale) House 1 $0 $0 House 2 $0 $0 House 3 $0 $0 House 4 $0 $0 House 5 $0 $0 House 6 $0 $0 House 7 $0 $0 House 8 $0 $0 EXPECTED PROPOSED ESTIMATED ESTIMATED RENTAL 75% of MONTHLY COST IS PROPOSED DOWN-PAYMENT FIRST MONTHLY MONTLY MONTHLY INCOME EXPECTED (trended to SALE PRICE ASSISTANCE MORTGAGE TAXES INSURANCE CONDO FEES (trended to RENTAL Expected Year of ALLOWABLE? LOAN PAYMENT LOAN PAYMENT Expected Year fo INCOME Sale)* Sale) House 1 $0 $0 $0 $0 $0 N/A House 2 $0 $0 $0 $0 $0 N/A House 3 $0 $0 $0 $0 $0 N/A House 4 $0 $0 $0 $0 $0 N/A House 5 $0 $0 $0 $0 $0 N/A House 6 $0 $0 $0 $0 $0 N/A House 7 $0 $0 $0 $0 $0 N/A House 8 $0 $0 $0 $0 $0 N/A C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls / Homeownership Sales Proceeds 9 of 35 • Exhibit 6.2 - HOMEOWNERSHIP SALES PROCEEDS Submission Date: RENTAL INCOME to MULTIFAMILY OWNER Utility Allowance "X" all that Apply Enter Tenant Paid Utility Allowance for all the Apply Energy Source Owner Paid Tenant Paid 0BR 1BR 2BR 3BR 4BR (ie: gas, electric) Heating Hot Water Cooking Lighting Air Cond. Other Total $0.00 $0.00 $0.00 $0.00 $0.00 Source of Utility Calculation: x UTILITY NET TENANT ESTIMATED EXPECTED GROSS GROSS RENT RENTAL MAXIMUM ALLOWANCE PAID RENT MONTHLY TARGET RENTAL NUMBER OF PROPOSED TRENDED TO INCOME ALLOWABLE TRENDED TO TRENDED TO RENTAL AMI %* BEDROOMS TENANT PAID EXPECTED (trended to GROSS RENT** EXPECTED EXPECTED SUBSIDY per RENT** YEAR OF SALE Expected Year YEAR OF SALE YEAR OF SALE UNIT of Sale) House 1 - Rental Unit 1 $0 $0.00 $0 $0 House 1 - Rental Unit 2 $0 $0.00 $0 $0 House 2 - Rental Unit 1 $0 $0.00 $0 $0 House 2 - Rental Unit 2 $0 $0.00 $0 $0 House 3 - Rental Unit 1 $0 $0.00 $0 $0 House 3 - Rental Unit 2 $0 $0.00 $0 $0 House 4 - Rental Unit 1 $0 $0.00 $0 $0 House 4 - Rental Unit 2 $0 $0.00 $0 $0 House 5 - Rental Unit 1 $0 $0.00 $0 $0 House 5 - Rental Unit 2 $0 $0.00 $0 $0 House 6 - Rental Unit 1 $0 $0.00 $0 $0 House 6 - Rental Unit 2 $0 $0.00 $0 $0 House 7 - Rental Unit 1 $0 $0.00 $0 $0 House 7 - Rental Unit 2 $0 $0.00 $0 $0 House 8 - Rental Unit 1 $0 $0.00 $0 $0 House 8 - Rental Unit 2 $0 $0.00 $0 $0 * Include the percentage at the top of the income range. For example, Incomes between 25% and 50% of AMI should be entered as 50%. ** Gross Proposed Tenant Paid Rents should be proposed rents for the current year, as compared to the HUD maximum allowable rents. Utility allowances are then deducted from Gross rents to equal Net Tenant Paid Rent below. C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls / Homeownership Sales Proceeds 10 of 35 • Exhibit 6.3.b - HOMEOWNERSHIP SUBSIDY WORKSHEET Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 Determining Developer's Subsidy Model 1 Model 1 Model 2 Model 2 Model 3 Model 3 AMI 60% AMI 80% AMI 60% AMI 80% AMI 60% AMI 80% Determining Per Unit - Developer's Subsidy Total Development Cost Fair Market Value Developer's Subsidy (Per Unit) $ - $ - $ - $ - $ - $ - Determining Project - Developer's Subsidy Developer's Subsidy (Per Unit) $ - $ - $ - $ - $ - $ - Number of DECD Units Developer's Subsidy (Per Model) $ - $ - $ - $ - $ - $ - Total Developer's Subsidy $ - Determining Homebuyer's Subsidy Determining Per Unit - Homebuyer's Subsidy Fair Market Value (Sales Price) (Per Unit) $ - $ - $ - $ - $ - $ - Affordable Price (Per Unit)* $ - Homebuyer's Subsidy (Per Unit) $ - $ - $ - $ - $ - $ - Number of DECD Units Homebuyer's Subsidy (Per Model) $ - $ - $ - $ - $ - $ - Total Homebuyer's Subsidy $ - Determining Total HOME Subsidy Total Developer's Subsidy $ - Total Homebuyer's Subsidy $ - Total DECD Subsidy to Project $ - *Estimate only. The actual amount is based on the income of the family buying the unit. C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ HO Subsidy Worksheet 11 of 35 • Exhibit 6.3.c - DEVELOPMENT CASH FLOW ANALYSIS FOR SINGLE FAMILY HOUSING PROJECTS Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 CONSTRUCTION LOAN INFORMATION ANNUAL AMOUNT TERM RATE MONTH 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 NUMBER OF HOUSING STARTS PROJECT EXPENSES LAND ACQUISITION SITE PLANNING ARCH. & ENGINEERING SITE IMPROVEMENTS UTILITIES CONSTRUCTION CONSTRUCTION INTEREST N/A - - - - - - - - - - - - - - - - - FEES OTHER SOFT COSTS TOTAL MONTHLY PROJECT EXPENSES $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - CUMULATIVE PROJECT EXPENSES $0 $0 $ - $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 NUMBER OF HOME CLOSINGS PROJECT REVENUE Cost of Sales 0% SALES $ - LESS COST OF SALES - NET MONTHLY PROJECT REVENUE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 CASH FLOW NET MONTHLY PROJECT REVENUE $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 LESS TOTAL MONTHLY PROJ. EXPEN. $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 CASH FLOW + ( - ) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 USES OF CASH FLOW DEBT REPAYMENT $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Equity Repayment $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 HOME LOAN REPAYMENT $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 TOTAL USES OF MONTHLY CASH FLOW $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 SOURCES OF INVESTMENT DEBT + OWNER EQUITY + DECD HOME (CHECK AT RIGHT IF A CONSTRUCTION LOAN) Check if a HOME Construction Loan TOTAL SOURCES OF MONTHLY INVEST. $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 INVESTMENT SUMMARY OUTSTANDING DEBT PREVIOUS MONTH'S OUTSTANDING DEBT N/A $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 - CASH FLOW FOR DEBT REPAYMENT N/A $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 + THIS MONTH'S INVESTED DEBT (7A) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 = OUTSTANDING DEBT $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 EQUITY INVESTED PREVIOUS MONTH'S EQUITY INVESTED N/A $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 - THIS MONTH'S EQUITY REPAYMENT N/A $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 + THIS MONTHS EQUITY INVESTED $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 = EQUITY INVESTED $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 HOME LOAN INVESTED PREVIOUS MONTH'S HOME INVESTED N/A $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 -THIS MONTH'S HOME REPAYMENT N/A $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 + THIS MONTH'S EQUITY INVESTED $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 = TOTAL HOME INVESTED $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ HO Cash Flow 12 of 35 • Exhibit 7.7.a - GUIDEFORM RELOCATION ASSISTANCE PLAN Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 Chapter 135, CGS, Uniform Relocation Assistance Act Consistent with the goals and objectives of activities assisted under the Connecticut Uniform Relocation Assistance Act (the Act) the will take the following steps to minimize displacement of persons, families, businesses and farms: A. PROGRAM DEVELOPMENT a) will review all projects proposed for funding for potential displacement impact. b) If a potential displacement impact is identified, shall require that the project budget provide adequate funds and resources either through DECD funds or other means to meet the requirements of Chapter 135, CGS. c) shall maintain written documentation detailing its review of all projects with DECD funds with regard to displacement/relocation and shall set forth the reason for its determinations in accordance with this Plan. B. PROGRAM IMPLEMENTATION a) shall not obligate or expend DECD funds for a project which is identified under Section A (b) above if the project will 1) directly result in the demolition of occupied or vacant occupiable units 2) will result in a conversion of those units to a use other than low/moderate-income housing, or 3) will cause displacement of persons, families, businesses or farms unless a relocation plan has been submitted to and approved by DECD. NOTE: A DECD form “Sworn Certificate of Non-Displacement” is to be executed for each project funded by DECD, whether or not relocation is anticipated to occur. b) shall adopt the requirements of Chapter 135, CGS and require that any project recipients funded by DECD funds provide the relocation assistance required in carrying out any displacement and/or relocation activities in accordance with a DECD approved relocation plan. c) shall require this to demonstrate its concern for displacement, both direct and indirect and its commitment to the principles of the Act. d) If displacement does occur, will carry out such relocation (or cause the project developer/recipient to carry out such relocation) in conformance with Chapter 135, CGS, and provide such replacement housing and relocation assistance as required the Act. shall document its files for any project which requires displacement, demolition or rehabilitation relating to conversion with the following information: 1) A description of the proposed assisted activity; 2) The general location on a map and approximate number of dwelling units by size (number of bedrooms) that will be demolished or converted to a use other than low/moderate-income dwelling units as a direct result of the assisted activity. 3) A time schedule for the commencement and completion of the demolition or conversion. 4) The general location on a map and approximate number of dwelling units by size (number of bedrooms) that will be provided as replacement dwelling units; 5) The source of funding and a time schedule for the provision of replacement dwelling units; 6) Records of all occupants and copies of all appropriate notices to displaced persons, families, businesses, or farms; and 7) Records of all payments made as a result of relocation activities. e) This information shall be provided to DECD as outlined above. f) This Plan is submitted and signed by an official of as a demonstration of its commitment to carry out the requirements of the Act. C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Relocation Guideform 13 of 35 • Exhibit 7.7.b - SWORN CERTIFICATE OF NON-DISPLACEMENT Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 SWORN CERTIFICATION OF NONDISPLACEMENT/NO LOSS OF UNITS IN LIEU OF RESIDENTIAL ANTIDISPLACEMENT AND RELOCATION PLAN – VACANT LAND OR VACANT BUILDINGS WITH SAME NUMBER OF RESIDENTIAL UNITS OR OWNER- OCCUPIED SINGLE FAMILY ACCESSIBILITY MODIFICATIONS I have read the requirements of the Federal Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended (URA) and Section 104 (d) of the Housing and Community Development Act of 1974, as amended (Barney Frank); and having been duly sworn, do hereby certify that: Check off all provisions that apply: Because the proposed housing will be developed on completely vacant land, that has no active businesses, farm operations or nonprofit uses, the development will not cause any temporary or 1. permanent displacement. Because the proposed housing will be developed in completely vacant structures, which have been vacant for at least one year prior to any contact with the Department of Economic and Community Development and which contain no active businesses, farm operations or nonprofit uses, the 2. development will not cause any temporary or permanent displacement. 3. There will be no demolition of residential units or portions of residential units. There will be no conversion of residential units to uses other than lower income dwelling units. 4. (“Other non-residential uses” includes emergency shelters.) All occupied and vacant occupiable lower income dwelling units that are demolished or converted to 5. other uses shall be replaced on a one-for-one basis with comparable lower income dwelling units. Because funds are being used to assist owner-occupied single family homeowners in making 6. accessibility modifications to their premises, there shall be no displacement or loss of units.  If Section 104(d) applies: “Occupiable” is defined as occupied at any time (except by squatters) within a 3-month period prior to execution of a contract for demolition or rehabilitation; a unit in standard condition; or a substandard unit that is suitable for rehabilitation.  Replacement units shall meet federal requirements at 42.375(b) (1)-(5) of 24 CFR Part 42, effective 11/4/96. Signature Title Date Sworn and subscribed before me this day of _______________, 20___. Commissioner of the Superior Court/Notary Public Official Stamp (Notary) My Commission Expires on: Note: I am unable to certify to the above, and I understand that a Relocation Plan will therefore be a required submission. Signature Title Date C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Sworn Cert. of Non-Displacement 14 of 35 • Exhibit 8.1.b. - FAIR HOUSING LAW VIOLATIONS Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 Please indicate below any finding of a violation of any Federal or State laws for regulations pertaining to fair housing, housing accessibility or non-discrimination in the area of rental housing. For this purpose, a finding is one made by a Federal or State court, or a Federal or State agency having authority and jurisdiction to make such finding. If there are no such findings, please state “none”. False statements made herein are punishable under the penalty for false statements set out in C.G.S. Section 53a-157b. None Violation finding(s) – explain: By: General Partner By: Print Name Signature Signed, sealed and delivered in the presence of: By: Witness By: Notary My commission expires: (NOTARY PUBLIC SEAL) C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Fair Housing Law 15 of 35 • Exhibit 8.1.d - FAIR HOUSING IMPACTS Submission Date: DEVELOPMENT NAME APPLICANT 0 0 Please provide a brief explanation as to how the proposed project or program will address the fair housing and equal opportunity factors identified below. Projects will be rated and ranked based on how well they address these factors. 1. Does the project provide a type of tenure (ownership, rental, cooperative) that is under-represented in the neighborhood? 2. Does the project provide for a household type (large family, special needs, elderly) that is under-represented in the neighborhood? 3. Does the project serve income ranges that are under-represented in the neighborhood? 4. Does the location of the project promote diversity and/or economic integration in the neighborhood? 5. What will be the special features of the fair housing marketing plan designed to promote diversity and economic integration in the neighborhood? C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Fair Housing 16 of 35 C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Fair Housing 17 of 35 • Exhibit 8.1.e. - AA5 AFFIRMATIVE FAIR Submission Date: HOUSING MARKETING PLAN DEVELOPMENT NAME 0 APPLICANT 0 1. INTRODUCTION Each applicant shall carry out an Affirmative Marketing Program to attract buyers or tenants of all minority and non-minority groups to the housing that the applicant is providing. These groups include White (Non-Hispanic) and members of minority groups: Blacks (Non-Hispanic), American Indians/Alaskan Natives, Hispanics and Asian/Pacific Islanders in the Metropolitan Statistical Area (MSA) or housing market area who may be subject to housing discrimination. At least 20 percent of the units must be targeted to the group(s) identified as “least likely to apply.” Groups “least likely to apply” include people with disabilities. 2. APPLICATION AND PROJECT IDENTIFICATION A. Applicants: B. Project or App. Number: Name: Number of Units: Address (City, State & Zip Code): Price or Rental Range of Units From $ To $ Telephone #: C. Project: D. Approximate Starting Dates: Name: Advertising: Occupancy: Address (City, State and Zip Code): E. Name of Managing/Sales Agent: Address (Include City, State, Zip Code): County: Census Tract: F. For Multifamily Housing Only: Elderly Non-Elderly 3. TYPE OF AFFIRMATIVE MARKETING PLAN Project Plan: Annual Plan (for single family) scattered site units. NOTE: a Separate Annual Plan must be developed for each type of census tract in which housing is to be built. Minority Area White (non-minority area) Mixed Area (with % of minority residents). 4. DIRECTION OF MARKETING ACTIVITY Indicate below which group(s) in the housing market area are least likely to apply for the housing because of its location and other factors without special outreach efforts. White (non-hispanic) Black Non-Hispanic American Indian or Alaskan native Hispanic Asian or Pacific Islander People with disabilities, (Family Housing only, See Instructions). 5. MARKETING PROGRAM: A. COMMERCIAL MEDIA Check the media to be use to advertise the availability of this housing. News paper(s)/Publications Radio T.V. Billboards Other (specify) Name of Newspaper or TV Racial/Ethic Identification of Size/Duration of Advertising Media Targeted to People with Station Readers/Audiencer Disabilities (1) (2) (3) (4) C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ AA-5 18 of 35 B. BROCHURE, SIGNS, AND FAIR HOUSING POSTER: (1) Will brochures, leaflets, or handouts be used to advertise? Yes No If yes, attach a copy or submit when available. (2) For project site sign; indicate sign size (3) Fair Housing Poster must be conspicuously displayed whenever sales/rentals and showing take place. Where will they be displayed? Sales/rental Offices(s); Real Estate Offices(s); Model Unit(s); Other: C. COMMUNITY CONTACTS To further inform the group(s) least likely to apply about the availability of the housing, the applicant agrees to establish and maintain contact with the groups/organizations listed below that are located in the housing market area of SMSA. If more space is needed, attach, an additional sheet. Notify DECD of any changes in this list. Attach a copy of correspondence to be mailed to these groups/organizations. (Provide all requested information). Name of Group/Organization Group Identification Approximate Date of Contact or Person Contacted or to be Contacted Proposed Contact contacted (1) (2) (3) (4) Address and Telephone # Method of Contacts Indicate the Specific Function/Group Organization will undertake in (5) (6) (7) 6. FUTURE MARKETING ACTIVITIES Check the block(s) that best describe future marketing activities to fill vacancies as they occur after the project has been initially occupied. Newspaper/Publications Radio TV Brochures/Leaflets/Handouts Site Signs Community Contacts Others Specify: 7. ANTICIPATED OCCUPANCY/RESULTS State in number of units the racial/ethnic mix of occupants anticipated as a result of the implementation of this affirmative marketing plan. White (Non-Hispanic) Black (Non-Hispanic) American Indian or Alaskan native Hispanic Asian or Pacific Islander People with Disabilities 8. EXPERIENCE AND STAFF INSTRUCTIONS A. Indicate any experience in marketing housing to the group(s) identified as least likely to apply. Yes No B. Indicate training to be provided to staff on federal, state, and local fair housing laws and regulations, as well as this AFHM Plan. Attach a copy of the instructions to staff regarding fair housing. 9. ADDITIONAL CONSIDERATIONS A. Submission of Fair Housing Policy Statement B. What system of Selection Criteria will be utilized for this Project? Submit a copy. 10. By signing this form, the applicant agrees, after appropriate consultation with DECD to change any part of the plan covering a multifamily project to assure continued compliance with Affirmative Fair Housing Marketing Regulations. Signature of Person Submitting Plan: Name (Type or Print): Title and Company: Date: **FOR DECD USE ONLY** Approved By: Disapproved By: Signature: Signature: Name: Name: Title: Title: Date: Date: C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ AA-5 19 of 35 • Exhibit 9.1.b - UPDATED CONTRACTING REQUIREMENTS Submission Date: Pursuant to Public Act 07-1 DEVELOPMENT NAME 0 APPLICANT 0 (1) Agency Notice to State Contractors and Prospective State Contractors REQUIREMENT: All agencies must notify their state contractors and prospective state contractors about the campaign solicitation and contribution ban. Further, all agencies must obtain written acknowledgement from such contractors that they have received the notice and have informed their principals about the ban. SEEC has provided the agencies with a notice (form) for this purpose. Note: See notice for definitions of terms. APPLICABILITY: Current Contracts; Pending Solicitations; Prequalifications; Future & Amended Contracts PROCEDURE FOR CURRENT CONTRACTS; PENDING SOLICITATIONS; PREQUALIFICATIONS: OPM directs each agency to send a hard copy of SEEC Form 10 to each of their current, prospective, and prequalified contractors. Each such contractor must return the completed form to the agency. See attached SEEC Form 10. PROCEDURE FOR FUTURE SOLICITATIONS; FUTURE & AMENDED CONTRACTS: Going forward, OPM strongly recommends that each agency include language concerning the ban in the agency’s boilerplate for solicitations and for contracts. Doing so will make the agency’s obligation to give notice, and the contractor’s obligation to acknowledge receipt of such notice, an integral part of the agency’s standard solicitation and contracting processes. By signing the solicitation or contract, the authorized signatory expressly acknowledges receipt of the notice and, thus, avoids having the contractor separately complete and return SEEC Form 10 to the agency. Note: Agencies that do not implement OPM’s recommendation must follow the Procedure for Current Contracts; Pending Solicitations; Prequalifications (above) to satisfy the notice requirement. OPM has developed the following standardized language for agencies to include in their boilerplate for solicitations and for contracts. This language, which the Office of Attorney General (OAG) has approved for agency use, is as follows: Standardized language for inclusion in agency’s solicitation boilerplate: “With regard to a State contract as defined in P.A. 07-1 having a value in a calendar year of $50,000 or more or a combination or series of such agreements or contracts having a value of $100,000 or more, the authorized signatory to this submission in response to the State's solicitation expressly acknowledges receipt of the State Elections Enforcement Commission's notice advising prospective state contractors of state campaign contribution and solicitation prohibitions, and will inform its principals of the contents of the notice. See Attachment __ [SEEC Form 11].” Standardized language for inclusion in agency’s contract boilerplate: “For all State contracts as defined in P.A. 07-1 having a value in a calendar year of $50,000 or more or a combination or series of such agreements or contracts having a value of $100,000 or more, the authorized signatory to this Agreement expressly acknowledges receipt of the State Elections Enforcement Commission's notice advising state contractors of state campaign contribution and solicitation prohibitions, and will inform its principals of the contents of the notice. See Attachment __ [SEEC Form 11].” Per the standardized language, agencies must attach a copy of SEEC Form 11 to all future solicitations, future contracts, and amended contracts. Unlike SEEC Form 10, SEEC Form 11 does not have the fillable fields at the bottom of the page. See attached SEEC Form 11. (2) Agency Reports to SEEC The new law requires that each agency submit an initial list with the names of their state contractors and prospective contractors to SEEC. Each month thereafter, each agency must report to SEEC any changes, additions, or deletions to its list of contractors. OPM, the Office of the State Comptroller (OSC), and SEEC are developing the procedures that agencies will follow to satisfy their reporting requirements under the law. More information will be forthcoming shortly. C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ SEEC-10 20 of 35 SEEC FORM 10 NOTICE TO EXECUTIVE BRANCH STATE CONTRACTORS AND PROSPECTIVE STATE CONTRACTORS OF CAMPAIGN CONTRIBUTION AND SOLICITATION BAN This notice is provided under the authority of Connecticut General Statutes 9-612(g)(2), as amended by P.A. 07-1, and is for the purpose of informing state contractors and prospective state contractors of the following law (italicized words are defined on page 2): Campaign Contribution and Solicitation Ban No state contractor, prospective state contractor, principal of a state contractor or principal of a prospective state contractor , with regard to a state contract or state contract solicitation with or from a state agency in the executive branch or a quasi-public agency or a holder, or principal of a holder of a valid prequalification certificate, shall make a contribution to, or solicit contributions on behalf of (i) an exploratory committee or candidate committee established by a candidate for nomination or election to the office of Governor, Lieutenant Governor, Attorney General, State Comptroller, Secretary of the State or State Treasurer, (ii) a political committee authorized to make contributions or expenditures to or for the benefit of such candidates, or (iii) a party committee; In addition, no holder or principal of a holder of a valid prequalification certificate, shall make a contribution to, or solicit contributions on behalf of (i) an exploratory committee or candidate committee established by a candidate for nomination or election to the office of State senator or State representative, (ii) a political committee authorized to make contributions or expenditures to or for the benefit of such candidates, or (iii) a party committee. Duty to Inform State contractors and prospective state contractors are required to inform their principals of the above prohibitions, as applicable, and the possible penalties and other consequences of any violation thereof. Penalties for Violations Contributions or solicitations of contributions made in violation of the above prohibitions may result in the following civil and criminal penalties: Civil penalties--$2000 or twice the amount of the prohibited contribution, whichever is greater, against a principal or a contractor. Any state contractor or prospective state contractor which fails to make reasonable efforts to comply with the provisions requiring notice to its principals of these prohibitions and the possible consequences of their violations may also be subject to civil penalties of $2000 or twice the amount of the prohibited contributions made by their principals. Criminal penalties—Any knowing and willful violation of the prohibition is a Class D felony, which may subject the violator to imprisonment of not more than 5 years, or $5000 in fines, or both. Contract Consequences Contributions made or solicited in violation of the above prohibitions may result, in the case of a state contractor, in the contract being voided. Contributions made or solicited in violation of the above prohibitions, in the case of a prospective state contractor, shall result in the contract described in the state contract solicitation not being awarded to the prospective state contractor, unless the State Elections Enforcement Commission determines that mitigating circumstances exist concerning such violation. The state will not award any other state contract to anyone found in violation of the above prohibitions for a period of one year after the election for which such contribution is made or solicited, unless the State Elections Enforcement Commission determines that mitigating circumstances exist concerning such violation. Receipt acknowledged: (Signature) (Date) Print name: Title: Company Name: Additional information and the entire text of P.A 07-1 may be found on the website of the State Elections Enforcement Commission, www.ct.gov/seec. Click on the link to “State Contractor Contribution Ban” C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ SEEC-10 21 of 35 Definitions: "State contractor" means a person, business entity or nonprofit organization that enters into a state contract. Such person, business entity or nonprofit organization shall be deemed to be a state contractor until December thirty-first of the year in which such contract terminates. "State contractor" does not include a municipality or any other political subdivision of the state, including any entities or associations duly created by the municipality or political subdivision exclusively amongst themselves to further any purpose authorized by statute or charter, or an employee in the executive or legislative branch of state government or a quasi-public agency, whether in the classified or unclassified service and full or part-time, and only in such person's capacity as a state or quasi- public agency employee. "Prospective state contractor" means a person, business entity or nonprofit organization that (i) submits a response to a state contract solicitation by the state, a state agency or a quasi-public agency, or a proposal in response to a request for proposals by the state, a state agency or a quasi-public agency, until the contract has been entered into, or (ii) holds a valid prequalification certificate issued by the Commissioner of Administrative Services under section 4a-100. "Prospective state contractor" does not include a municipality or any other political subdivision of the state, including any entities or associations duly created by the municipality or political subdivision exclusively amongst themselves to further any purpose authorized by statute or charter, or an employee in the executive or legislative branch of state government or a quasi-public agency, whether in the classified or unclassified service and full or part-time, and only in such person's capacity as a state or quasi-public agency employee. "Principal of a state contractor or prospective state contractor" means (i) any individual who is a member of the board of directors of, or has an ownership interest of five per cent or more in, a state contractor or prospective state contractor, which is a business entity, except for an individual who is a member of the board of directors of a nonprofit organization, (ii) an individual who is employed by a state contractor or prospective state contractor, which is a business entity, as president, treasurer or executive vice president, (iii) an individual who is the chief executive officer of a state contractor or prospective state contractor, which is not a business entity, or if a state contractor or prospective state contractor has no such officer, then the officer who duly possesses comparable powers and duties, (iv) an officer or an employee of any state contractor or prospective state contractor who has managerial or discretionary responsibilities with respect to a state contract, (v) the spouse or a dependent child who is eighteen years of age or older of an individual described in this subparagraph, or (vi) a political committee established or controlled by an individual described in this subparagraph or the business entity or nonprofit organization that is the state contractor or prospective state contractor. "State contract" means an agreement or contract with the state or any state agency or any quasi-public agency, let through a procurement process or otherwise, having a value of fifty thousand dollars or more, or a combination or series of such agreements or contracts having a value of one hundred thousand dollars or more in a calendar year, for (i) the rendition of services, (ii) the furnishing of any goods, material, supplies, equipment or any items of any kind, (iii) the construction, alteration or repair of any public building or public work, (iv) the acquisition, sale or lease of any land or building, (v) a licensing arrangement, or (vi) a grant, loan or loan guarantee. "State contract" does not include any agreement or contract with the state, any state agency or any quasi-public agency that is exclusively federally funded, an education loan or a loan to an individual for other than commercial purposes. "State contract solicitation" means a request by a state agency or quasi-public agency, in whatever form issued, including, but not limited to, an invitation to bid, request for proposals, request for information or request for quotes, inviting bids, quotes or other types of submittals, through a competitive procurement process or another process authorized by law waiving competitive procurement. “Managerial or discretionary responsibilities with respect to a state contract” means having direct, extensive and substantive responsibilities with respect to the negotiation of the state contract and not peripheral, clerical or ministerial responsibilities. “Dependent child” means a child residing in an individual’s household who may legally be claimed as a dependent on the federal income tax of such individual. “Solicit” means (A) requesting that a contribution be made, (B) participating in any fund-raising activities for a candidate committee, exploratory committee, political committee or party committee, including, but not limited to, forwarding tickets to potential contributors, receiving contributions for transmission to any such committee or bundling contributions, (C) serving as chairperson, treasurer or deputy treasurer of any such committee, or (D) establishing a political committee for the sole purpose of soliciting or receiving contributions for any committee. Solicit does not include: (i) making a contribution that is otherwise permitted by Chapter 155 of the Connecticut General Statutes; (ii) informing any person of a position taken by a candidate for public office or a public official, (iii) notifying the person of any activities of, or contact information for, any candidate for public office; or (IV) serving as a member in any party committee or as an officer of such committee that is not otherwise prohibited in this section. C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ SEEC-10 22 of 35 • Exhibit 9.2 - OWNER'S AFFIDAVIT Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 State of Connecticut } } , Connecticut s.s. _______________, Connecticut County of } Date 1. I am over the age of 18. 2. I understand the obligation of an oath. 3. The property identified in the attached description (Exhibit A) is presently owned by enter legal name which party is an individual, corporation, partnership, other (please describe) 4. If the owner is other than an individual, a list of the owners, principals, officers, and/or Board of Directors is attached. 5 The property identified in the attached description (Exhibit A) which is the identified parcel being purchased by which I am an officer on ,20 from for the price of $ which price was actually paid by me or the organization of which I am an officer. 6. Where the property originally purchased is not the identical parcel being purchased by the DECD grantee, the owner or representative must explain how much was originally paid for the entire parcel, how much of the parcel is being sold, and what he/she estimates was the proportional cost of that portion of the parcel being sold to the DECD grantee, and how this proportional 7. This property acquisition represented an arm’s length, market rate transaction with a seller who was not related by blood, marriage or business association. 8 If the acquisition did not represent an arm’s length, market rate transaction, the last arm’s length, market rate transaction occurred on , 20 between (seller) and (buyer) for the price of $ 9. The following expenditures which can be documented by records in my possession or in the possession of the organization of which I am an officer, have been made to obtain local approvals and/or to physically improve the property. Expenditure Date Payee C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Owners Affadavit 23 of 35 10. The following indebtedness has been secured by liens against this property: Lien Holder Amount Due Date Due 11. I hereby state that the foregoing is true to the best of my knowledge and belief. 12. I understand that I may be prosecuted for false statement under the laws of the State of Connecticut under Section 53a-157 of the General Statutes, as amended from time to time, for any false statement made herein. Signature of Owner or Authorized Representative Date Sworn and subscribed before me this day of , 20___. _______________, 20 Commissioner of the Superior Court/Notary Public Official Stamp (Notary) My Commission Expires on: C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Owners Affadavit 24 of 35 • Exhibit 9.3 - PREVIOUS PARTICIPATION CERTIFICATION Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 U.S. Department of Housing U.S. Department of Agriculture OMB Approval No. 2502-0118 Previous Participation and Urban Development Farmers Home Administration (exp. 9/30/2009) Certification Office of Housing/Federal Housing Commissioner Part I To be completed by Participants of Multifamily Projects. See Instructions For HUD/FmHA use only Reason for Submitting Certification 1. Agency Name and City where the application is filed 2. Project Name, Project Number, City and Zip Code contained in application 3. Loan or Contract Amount 4. Number of Units or Beds 5. Section of Act 6. Type of Project (check one) Existing Rehabilitation Proposed (New) List of All Proposed Principal Participants 7. Names and Addresses of All Known Principals and Affiliates (people, businesses & organizations) 8. Role of Each 9. Expected % Ownership 10. Social Security or IRS proposing to participate in the project described above (list names alphabetically; last, first, middle initial Principal in Project Interest in Project Employer Number Certifications: I (meaning the individual who 2. For the period beginning 10 years prior to the (A felony is defined as any offense punishable USDA's Standard of Conduct in 7 C.F.R. Part O signs as well as the corporations, partnerships or date of this certification, and except as shown by imprisonment for a term exceeding Subpart B. other parties listed above who certify) hereby by me on the certification. one year, but does not include any offense 5. I am not a principal participant in an assisted or apply to HUD or USDA-FmHA, as the case may a. No mortgage on a project listed by me has classified as a misdemeanor under the laws insured project as of this date on which construc- be, for approval to participate as a principal in the ever been in default, assigned to the Government of a State and punishable by imprisonment of tion has stopped for a period in excess of role and project listed above based upon my or foreclosed, nor has mortgage relief two years or less); 20 days or which has been substantially completed following previous participation record and this by the mortgagee been given; f. I have not been suspended, debarred or for more than 90 days and documents for Certification. b. I have not experienced defaults or otherwise restricted by any Department or closing, including final cost certification have I certify that all the statements made by me are noncompliances under any Conventional Agency of the Federal Government or of a not been filed with HUD or FmHA. true, complete and correct to the best of my Contract or Turnkey Contract of Sale in connection State Government from doing business with 6. To my knowledge I have not been found by HUD knowledge and belief and are made in good faith, with a public housing project; such Department or Agency. or FmHA to be in noncompliance with any including the data contained in Schedule A and c. To the best of my knowledge, there are no g. g. I have not defaulted on an obligation covered applicable civil rights laws. Exhibits signed by me and attached to this form. unresolved findings raised as a result of HUD by a surety or performance bond and have 7. I am not a Member of Congress or a Resident Warning: HUD will prosecute false claims and audits, management reviews or other Governmental not been the subject of a claim under an Commissioner nor otherwise prohibited or limited statements. Conviction may result in criminal and/ investigations concerning me or employee fidelity bond. by law from contracting with the Government or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 my projects; 3. All the names of the parties, known to me to be of the United States of America. U.S.C. 3729, 3802) d. There has not been a suspension or termination principals in this project(s) in which I propose to 8. Statements above (if any) to which I cannot certify I further certify that: of payments under any HUD assistance participate, are listed above. have been deleted by striking through the words 1. Schedule A contains a listing of every assisted contract in which I have had a legal or beneficial 4. I am not a HUD/FmHA employee or a member with a pen. I have initialed each deletion (if any) or insured project of HUD, USDA-FmHA and interest; of a HUD/FmHA employee's immediate house- and have attached a true and accurate signed State and local government housing finance e. I have not been convicted of a felony and am hold as defined in Standards of Ethical Conduct statement (if applicable) to explain the facts and agencies in which I have been or am now a not presently, to my knowledge, the subject for Employees of the Executive Branch in 5 circumstances which I think helps to qualify me as principal. of a complaint or indictment charging a felony. C.F.R. Part 2635 (57 FR 35006) and HUD's a responsible principal for participation in this Standard of Conduct in 24 C.F.R. Part O and project. C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Previous Participation 25 of 35 Type or Printed Name of Principal Signature of Principal Certification Date (mm/dd/yyyy) Area Code and Telephone No. This Form was prepared by (Please print Name): Area Code and Telephone No.: Previous editions are obsolete Page 1 of 2 ref Handbook 4065.1 form HUD-2530 (5/2001) Schedule A: List of Previous Projects and Section 8 Contracts. By my name below is the complete list of my previous projects and my participation history as a principal; in Multifamily Housing programs of HUD/FmHA, State, and Local Housing Finance Agencies. Note: Read and follow the instruction sheet carefully. Abbreviate where possible. Make full disclosure. Add extra sheets if you need more space. Double check for accuracy. If you have no prvious projects, write, by your name, "No previous participation, First Experience." 1. List each Principal's Name 2. List Previous Projects 3. List Principals' Role(s) 4. Status of Loan 5. Was Project ever in Default 6. Last MGMT (give the I.D., project name, city location, (current, defaulted, during your participation? and/or (list in alphabetical order, & government agency involved (indicate dates participated, and assigned, or Physical Inspctn last name first) if other then HUD) if fee or identity of interest participant foreclosed) Yes No If "Yes," explain Rating C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Previous Participation 26 of 35 Part II - For HUD Internal Processing Only Received and checked by me for accuracy and completeness; recommend approval or transferal to Headquarters as checked below: Date (mm/dd/yyyy) Telephone Number and Area Code A. No Advers information; form HUD-2530 C. Disclosure or Certification problem approval is recommended. Staff Processing and Control B. Name match in system D. Other, our memorandum is attached. Supervisor Director of Housing/Director, Multifamily Division Approved Date (mm/dd/yyyy) Previous editions are obsolete Page 2 of 2 ref Handbook 4065.1 form HUD-2530 (5/2001) Instructions for Completing the Previous Who Must Sign and File Form HUD-2530: Exemptions – The names of the following If you do request reconsideration by the Participation Certificate, form HUD-2530 Form HUD-2530 must be completed and signed parties do not need to be listed on form HUD- Review Committee and the reconsideration Carefully read these instructions and the ap- by all parties applying to become principal 2530: Public Housing Agencies, tenants, owners results in an adverse determination, you may plicable regulations. A copy of those regula- participants in HUD multifamily housing of less than five condominium or cooperative then request a hearing before a Hearing Officer. tions published at 24 C.F.R. 200.210 to 200.245 projects, including those who have no previous units and all others whose interests were The Hearing Officer will issue a report to can be obtained from the Multifamily Housing participation. The form must be signed acquired by inheritance or court order. the Review Committee. You will be notified of Representative at any HUD Office. Type or and filed by all principals and their affiliates Where and When Form HUD-2530 Must Be the final ruling by certified mail. print neatly in ink when filling out this form. who propose participating in the HUD project. Filed: The original of this form must be Specific Line Instructions: Mark answers in all blocks of the form. If the Use a separate form for each role in the submitted to the HUD Office where your project Reason for submitting this Certification: e.g., form is not filled completely, it will delay approval project unless there is an identity of interest. application will be processed at the same time refinance, management, change in ownership, of your application. Principals include all individuals, joint ventures, you file your initial project application. This transfer of physical assets, etc. Attach extra sheets as you need them. Be partnerships, corporations, trusts, nonprofit form must be filed with applications for projects, Block 1: Fill in the name of the agency to sure to indicate "Continued on Attachments" organizations, any other public or private or when otherwise required in the situations which you are applying. For example: HUD wherever appropriate. Sign each additional entity, that will participate in the proposed listed below: Office, Farmers Home Administration District page that you attach if it refers to you or your project as a sponsor, owner, prime contractor, • Projects to be financed with mortgages insured office, or the name of a State or local housing record. If you have many projects to list (20 or turnkey developer, managing agent, nursing under the National Housing Act (FHA). finance agency. Below that, fill in the name of more) and expect to be applying frequently for home administrator or operator, packager, or • Projects to be financed according to Section the city where the office is located. participation in HUD projects, you should con- consultant. Architects and attorneys who have 202 of the Housing Act of 1959 (Elderly and Block 2: Fill in the name of the project, such sider filing a Master List. See Master List any interest in the project other than an arms Handicapped). as "Greenwood Apts." If the name has not yet instructions below under "Instructions for Com- length fee arrangement for professional services • Projects in which 20 percent or more of the been selected, write "Name unknown." Below pleting Schedule A." are also considered principals by HUD. units are to receive a subsidy as described in that, enter the HUD contract or project identification Carefully read the certification before you In the case of partnerships, all general 24 C.F.R. 200.213. number, the Farmers Home Administration sign it. Any questions regarding the form or partners regardless of their percentage interest • Purchase of a project subject to a mortgage project number, or the State or local how to complete it can be answered by your and limited partners having a 25 percent or insured or held by the Secretary of HUD. housing finance agency project or contract HUD Office Multifamily Housing Representative. more interest in the partnership are considered • Purchase of a Secretary-owned project. number. Include all project or contract identification Purpose: This form provides HUD with a principals. In the case of public or private • Proposed substitution or addition of a principal, numbers that are relevant to the certified report of all previous participation in corporations or governmental entities, principals or principal participation in a different project. Also enter the name of the city in which HUD multifamily housing projects by those include the president, vice president, capacity from that previously approved for the project is located, and the ZIP Code of the parties making application. The information secretary, treasurer and all other executive the same project. site location. requested in this form is used by HUD to officers who are directly responsible to the • Proposed acquisition by an existing limited Block 3: Fill in the dollar amount requested in determine if you meet the standards estab- board of directors, or any equivalent governing partner of an additional interest in a project the proposed mortgage, or the annual amount lished to ensure that all principal participants body, as well as all directors and each resulting in a total interest of 25 percent or of rental assistance requested. in HUD projects will honor their legal, financial stockholder having a 10 percent or more interest more, or proposed acquisition by a corporate Block 4: Fill in the number of apartment units and contractual obligations and are accept- in the corporation. stockholder of an additional interest in a proposed, such as "40 units." For hospital able risks from the underwriting standpoint of Affiliates are defined as any person or project resulting in a total interest of 10 projects or nursing homes, fill in the number of an insurer, lender or governmental agency. business concern that directly or indirectly percent or more. beds proposed, such as "100 beds." HUD requires that you certify your record of controls the policy of a principal or has the • Projects with U.S.D.A., Farmers Home Ad- Block 5: Fill in the section of the Housing Act previous participation in HUD/USDA-FmHA, power to do so. A holding or parent corporation ministration, or with state or local government under which the application is filed. State and Local Housing Finance Agency would be an example of an affiliate if one housing finance agencies that include Block 7: Definitions of all those who are projects by completing and signing this form, of its subsidiaries is a principal. rental assistance under Section 8 of the considered principals and affiliates are given before your project application or participation Exception for Corporations – All principals Housing Act of 1937. For projects of this above in the section titled "Who Must Sign and can be approved. and affiliates must personally sign the certificate type, form HUD-2530 should be filed with the File...." HUD approval of your certification is a except in the following situation. When a appropriate applications directly to those Block 8: Beside the name of each principal, necessary precondition for your participation corporation is a principal, all of its officers, agencies. fill in the role that each will perform. The in the project and in the capacity that you directors, trustees and stockholders with 10 Review of Adverse Determination: If approval following are possible roles that the principals propose. If you do not file this certification, do percent or more of the common (voting) stock of your participation in a HUD project is may perform: Sponsor, Owner, Prime Contractor, not furnish the information requested accu- need not sign personally if they all have the denied, withheld, or conditionally granted on Turnkey Developer, Managing Agent, rately, or do not meet established standards, same record to report. The officer who is the basis of your record of previous participation, Packager, Consultant, General Partner, Limited HUD will not approve your certification. authorized to sign for the corporation or agency you will be notified by the HUD Office. Partner (include percentage), Executive Note that approval of your certification does will list the names and title of those who elect You may request reconsideration by the HUD Officer, Director, Trustee, Major Stockholder, not obligate HUD to approve your project ap- not to sign. However, any person who has a Review Committee. Alternatively, you may or Nursing Home Administrator. Beside the plication, and it does not satisfy all other HUD record of participation in HUD projects that is request a hearing before a Hearing Officer. name of each affiliate, write the name of the program requirements relative to your qualifi- separate from that of his or her organization Either request must be made in writing within person or firm of affiliation, such as "Affiliate of cations. must report that activity on this form and sign 30 days from your receipt of the notice of Smith Construction Co." his or her name. The objective is full disclosure. determination. C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Previous Participation 27 of 35 Previous Editions are obsolete ref Handbook 4065.1 form HUD-2530 (5/2001) Block 9: Fill in the percentage of ownership in Column 3 List the role(s) of your participation, and provide a telephone number where you HUD-2530"). Beside each signature, fill in the the proposed project that each principal is dates participated, and if fee or identity of can be reached during the day. No determinations role of each party (the same as shown in block 8). expected to have. Also specify if the participant interest with owners. will be made on these certificates. In addition, each person who signs the form is a general or limited partner. Beside the Column 4 Indicate the current status of the loan. File one copy of the Master List with each should fill in the date that he or she signs, as name of those parties who will not be owners, Except for current loans, the date associated with the HUD Office where you do business and mail well as providing a telephone number where write "None." status is required. Loans under a workout arrangement one copy to the following address: he or she can be reached during business Block 10: Fill in the Social Security Number are considered assigned. An explanation of the circum- hours. By providing a telephone number where or IRS employer number of every party listed, stances surrounding the status is required for all HUD-2530 Master List you can be reached, you will help to prevent including affiliates. noncurrent loans. Participation and Compliance any possible delay caused by mailing and Instructions for Completing Schedule A: Column 5 Explain any project defaults during Division – Housing processing time in the event HUD has any Be sure that Schedule A is filled-in completely, your participation. U.S. Department of Housing and questions. accurately and the certification is properly Column 6 Enter the latest Management and/ Urban Development dated and signed, because it will serve as a or Physical Inspection Review rating. If either 451 Seventh Street, S.W. If you cannot certify and sign the certification legal record of your previous experience. All of the ratings are below average, the report Washington, D.C. 20410 as it is printed because some statements Multifamily Housing projects involving HUD/ issued by HUD is required to be submitted do not correctly describe your record, use a FmHA, and State and local Housing Finance along with the applicant's explanation of the Once you have filed a Master List, you do not pen and strike through those parts that differ Agencies in which you have previously partici- circumstances surrounding the rating. need to complete Schedule A when you submit with your record, then sign and certify to that pated must be listed. Applicants are reminded form HUD-2530. Instead, write the name of remaining part which does describe you or that previous participation pertains to No Previous Record: Even if you have never the participant in column 1 of Schedule A and your record. the individual principal within an entity as well participated in a HUD project before, you must beside that write "See Master List on file." as the entity itself. A newly formed company complete form HUD-2530. If you have no Also give the date that appears on the Master Attach a signed letter, note or an explanation may not have previous participation, but the record of previous projects to list, fill in your List that you submitted. Below that, report all of the items you have struck out on the principals within the company may have had name in column 1 of Schedule A, and write changes and additions that have occurred certification and report the facts of your correct extensive participation and disclosure of that across the form by your name – "No previous since that date. Be sure to include any mortgage record. Item A(2)(e) relates to felony activity is required. To avoid duplication of participation, first experience." defaults, assignments or foreclosures convictions within the past 10 years. If you disclosure, list the project and then the entities not listed previously. have been convicted of a felony within 10 or individuals involved in that project. You Master List System: If you expect to file this If you have withdrawn from a project since years, strike out all of A(2)(e) on the certificate may use the name or a number code to denote form frequently and you have a long list of the date the Master List was filed, be sure to and attach your statement giving your explanation. the entity or individual that participated. The previous projects to report on Schedule A, you name the project. Give the project identification A felony conviction will not necessarily number code can then be used in column 3 to should consider filing a Master List. By doing number, the month and year your participation cause your participation to be disapproved denote role. so, you will avoid having to list all your previous began and/or ended. unless there is a criminal record or other Column 2 List the project or contract identifi- projects each time you file a new application. evidence that your previous conduct or method cation of each previous project. All previous To make a Master List, use form HUD- Certification: of doing business has been such that your projects must be included or your certifica- 2530. On page 1, in block 1, enter (in capital After you have completed all other parts of participation in the project would make it an tion cannot be processed. Include the name letters) the words "Master List." In blocks 2 form HUD-2530, including Schedule A, read unacceptable risk from the underwriting standpoint of all projects, the cities in which they are through 6 enter in "N.A." meaning Not Applicable. the Certification carefully. In the box below of an insurer, lender or governmental located and the government agency (HUD, Complete blocks 7 through 10. the statement of certification, fill in the name agency. USDA-FmHA or State or local housing finance In the box below the statement of certification, of all principals and affiliates (type or print agency) that was involved. At the end of your fill in the names of all parties who wish to neatly). Beside the name of each principal and list of projects, draw a straight line across the file a Master List together (type or print neatly). affiliate, each party must sign the form, with page to separate your record of projects from Beside each name, every party must sign the the exception in some cases of individuals that of others signing this form who have a form. In the box titled "Proposed Role," fill in associated with a corporation (see "Exception different record to report. N.A. Also, fill in the date you sign the form for Corporations" in the section of the instructions titled "Who Must Sign and File form The Department of Housing and Urban Development (HUD) is authorized to collect this information by law (42 U.S.C. 3535(d) and 24 C.F.R. 200.217) and by regulation at 24 CFR 200.210. This information is needed so that principals applying to participate in multifamily programs can become HUD-approved participants. The information you provide will enable HUD to evaluate your record with respect to established standards of performance, responsibility and eligibility. Without prior approval, a principal may not participate in a proposed or existing multifamily project. HUD uses this information to evaluate whether or not principals pose an unsatisfactory underwriting risk. The information is used to evaluate the potential principals and approve only individuals and organizations who will honor their legal, financial and contractual obligations. Privacy Act Statement: The Housing and Community Development Act of 1987, 42 U.S.C. 3543 requires persons applying for a Federally-insured or guaranteed loan to furnish his/her Social Security Number (SSN). HUD must have your SSN for identification of your records. HUD may use your SSN for automated processing of your records and to make requests for information about you and your previous records with other public agencies and private sector sources. HUD may disclose certain information to Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions. It will not be otherwise disclosed or released outside of HUD, except as required and permitted by law. You must provide all of the information requested in this application, including your SSN. Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. A response is mandatory. Failure to provide any of the information will result in your disapproval for participation in this HUD program. Previous Editions are obsolete ref Handbook 4065.1 form HUD-2530 (5/2001) C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Previous Participation 28 of 35 • Exhibit 9.10 - REQUEST FOR RELEASE Submission Date: FROM CONNECTICUT STATE HOUSING PROGRAM DEVELOPMENT NAME Sample Development APPLICANT Sample Applicant This is a request by (Housing Authority) for the release of (Housing Project) from the (please select the applicable program): Moderate Rental Elderly Congregate Moderate Rental Development State Housing Program Justification: (Please provide a brief description of the reason for release from the applicable program and how this action meets the intent of the statute) Executive Director Name Executive Director Signature Date C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Release of State Housing 29 of 35 • Exhibit 9.11 - REQUEST FOR REHAB OF Submission Date: FROM CONNECTICUT STATE HOUSING PROGRAM DEVELOPMENT NAME Sample Development APPLICANT Sample Applicant I, hereby certify that the development will be for the rehabilitation of existing State Housing Authority units. Developer/Sponsor Date C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Rehab of State Housing 30 of 35 • Exhibit 9.12.a - STATUTORY CHECKLIST Submission Date: Federal Laws and Authorities listed at Sec. 58.6 DEVELOPMENT NAME 0 APPLICANT 0 Not Applicable to This Project Approvals, Permits Obtained* Determination of consistency Conditions and/or Mitigation Consultation Required* Provide compliance documentation. Additional Permits Required* Review Required* Area of Statutory or Regulatory Compliance Actions Required material may be attached. Historic Properties Floodplain Management Wetlands Protection Coastal Zone Management Water Quality - Aquifers Endangered Species Wild and Scenic Rivers Air Quality Farmlands Protection Manmade Hazards: Thermal/Explosive Noise Airport Clear Zones Toxic Sites Environmental Justice * Attach evidence that required actions have been taken. C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Statutory Checklist 31 of 35 • Exhibit 9.12.a - STATUTORY CHECKLIST Submission Date: Federal Laws and Authorities listed at Sec. 58.6 STATUTORY CHECKLIST CONT. Federal Laws and Authorities listed at Sec. 58.6 and Permits, Licenses, Forms of Compliance Under Other Laws - Federal, State and Local DEVELOPMENT NAME 0 APPLICANT 0 Approvals, Permits Obtained* Not Applicable to This Project Determination of consistency Conditions and/or Mitigation Consultation Required* Other Areas of Statutory and Regulatory Compliance Provide compliance documentation. Additional Permits Required* Review Required* Actions Required Applicable to Project material may be attached. Federal Requirements Flood Insurance - 58.6(a) Coastal Barriers - 58.6(b) Airport Clear Zone Notification - 58.6(c) Water Quality Solid Waste Disposal Fish and Wildlife State or Local Statutes (to be added by Responsible Entity) x x Prepared By: Name Signature Title Date C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Statutory Checklist 32 of 35 • Exhibit 9.12.b. - ENVIRONMENTAL ASSESSMENT CHECKLIST Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 1 2 3 4 5 6 Impact Categories No Impact Potentially Potentially Potentially Needs Requires Source or Documentation Anticipated Beneficial Adverse Adverse Mitigation Project (Note date or contact or Requires Requires Modification page reference) Documentation More Study Additional material may be Only attached. Land Development Conformance With Comprehensive Plans and Zoning Compatibility and Urban Impact Slope Erosion Soil Suitability Hazards and Nuisances, Including Site Safety Energy Consumption Noise Effects of Ambient Noise on Project and Contribution to Community Noise Levels Air Quality Effects of Ambient Air Quality on Project and Contribution to Community Pollution Levels Environmental Design and Historic Values Visual Quality Coherence, Diversity, Compatible Use, and Scale Historic, Cultural, and Archaeological Resources Socioeconomic Demographic/ Character Changes Displacement Employment and Income Patterns Community Facilities and Services Education Facilities Commercial Facilities Health Care Social Services Solid Waste Waste Water Storm Water Water Supply C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Environmental Assessment 33 of 35 • Exhibit 9.12.b. - ENVIRONMENTAL ASSESSMENT CHECKLIST Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 1 2 3 4 5 6 Impact Categories No Impact Potentially Potentially Potentially Needs Requires Source or Documentation Anticipated Beneficial Adverse Adverse Mitigation Project (Note date or contact or Requires Requires Modification page reference) Documentation More Study Additional material may be Only attached. Public Safety Police Fire Emergency Medical Open Space and Recreation Open Space Recreation Cultural Facilities Transportation Natural Features Water Resources 1 2 3 4 4 5 6 7 Surface Water Floodplains Coastal Zone Unique Natural Features and Agricultural Lands Vegetation and Wildlife 1 2 3 4 4 5 6 7 Summary of Findings and Conclusions: Summary of Environmental Conditions: 1 2 3 4 4 5 6 7 C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Environmental Assessment 34 of 35 • Exhibit 9.12.b. - ENVIRONMENTAL ASSESSMENT CHECKLIST Submission Date: DEVELOPMENT NAME 0 APPLICANT 0 Projected Modifications and Alternatives Considered: 1 2 3 4 4 5 6 7 1 2 3 4 4 5 6 7 Additional Studies Performed (attach Study Summary) 1 2 3 Mitigation Measures Needed: 1 2 3 1. Is the project in compliance with applicable laws and regulations? Yes No 2. Is an EIS required? Yes No 3. A Finding of No Significant Impact (FONSI) can be made. Project will not significantly affect the quality of the human environment. Yes No Prepared By: Name Date Title C:\Docstoc\Working\pdf\12341b1a-2376-49c0-8848-cc84fd99ae03.xls \ Environmental Assessment 35 of 35