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Impacted Tenants List (Exhibit A) <br />This List will become Exhibit A of the Grant Agreement that you will enter into with the City of Santa Ana. <br />Households with a Housing Choice Voucher, also known as Section 8, or those who receive other <br />government rental assistance are not eligible. Tenants that you plan to evict are not eligible. It is your <br />decision to include which tenants qualify on this list. Please ensure you have: 1) a signed copy of the <br />Lease Agreement verifying occupancy for all tenants on the Impacted Tenants List for whom you are <br />seeking assistance; 2) documentation on rile for all tenants on the Impacted Tenants List that <br />demonstrate that the tenant has been impacted by Coronavirus and have lost jobs, had their work hours <br />reduced, or have experienced a loss of income due to the economic or health impacts of Coronavirus and <br />who have been unable to maintain their rent payments under their lease agreements. Insufficient or <br />missing documentation may cause a delay in processing or, in some cases, a denial of the application. <br />Additional documentation may be requested during the review of your application. 1 hereby attest that the <br />Impacted Tenants listed below will be released from any remaining obligation for any rent arrears owed <br />(209/6) following payment by the City of Santa Ana (809/6). <br />Property Name: Santa Ana Units Investment — DBA The Californian <br />Property Address: 3400 S. Main St. Santa Ana, CA 92707 <br />Tax ID for Payment: 95-6235321 <br />Full Name of Tenant <br />(as stated on the Lease) <br />Address of Tenant's Rental Unit <br />Total Amount <br />of Rent Arrears <br />Owed <br />Castillo, Austin <br />201 W. MacArthur Blvd. #B8 <br />$1,886.00 <br />Gonzalez, Jim <br />201 W. MacArthur Blvd. #F1 <br />$5,882.82 <br />Niggl, Lauren <br />3400 S. Main St. #F5 <br />$3,350.00 <br />Nunez, Victor <br />200 W. Columbine #B4 <br />$2,486.00 <br />Peters, Anthony <br />200 W. Columbine #B6 <br />$9,954.00 <br />Palmerin, Leonardo <br />200 W. Columbine #D2 <br />$6,706.18 <br />Howe, Julia <br />200 W. Columbine #E3 <br />$10,600.00 <br />Simpson, Justin <br />3410 S. Main St. #E3 <br />$14,210.00 <br />Flores, Maria <br />3410 S. Main St. #H8 <br />$13,038.35 <br />Total Amount of Assistance <br />Requested <br />$68,113.35 <br />-Add aaaruonai pages it necessary. It you have multiple properties and you are unable to <br />accept payment on behalf of all of them, please list each property separately and provide the <br />name of the property at the top of each list. <br />Coronavirus Emergency Rental Relief Fund for Landlords Page 13 <br />Application <br />