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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 file 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. I hereby attest that the <br />Impacted Tenants listed below will be released from any remaining obligation for any rent arrears owed <br />(20%) following payment by the City of Santa Ana (809,61). <br />Property Name: Bentley Parke Apartments <br />Property Address: 3200 West 5th Street, Santa Ana, CA 92703 <br />Tax ID for Payment: 9M914570 <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 />Zenon Altan1lf ano Huerta <br />3200 West 5th Street, Apt 309, Santa Ana, Ca 92703 <br />$ 2,065.00 <br />Iveth Guadalupe Martinez Morales <br />3200 West 5th Street, Apt 313, Santa Ana, Ca 92703 <br />$ 2,230.00 <br />Me Ines Alonzo 011veres, Eduardo 0livares <br />3200 West 5th Street, Apt 913, Santa Ana, Ca 92703 <br />$ 3,755.00 <br />Juana Maxima, Jesus Armando Cordlla, Oomlalupe To. <br />3200 West 5th Street, Apt 1201, Santa Ana, Ca 92703 <br />$ 7,100.00 <br />Rodolk Mamsez CnMenas, Made Do Louses Rablea <br />3200 West 5th Street, Apt 1307, Santa Ana, Ca 92703 <br />$ 2, 930.00 <br />Fmncisca J. Chevoz Mayo, Conydlo Almasi Lima Salinas <br />3200 West 5th Street, Apt 1308, Ca 92703 <br />$ 7,545.00 <br />Miriam Anita Lopez. Roman Milo Crvz, Sme Hernandez Seacho <br />3200 West 5th Street, Apt 1315, Ca 92703 <br />$ •1,865.00 <br />$ <br />Total Amount of Assistance <br />Requested <br />$ 27,490.00 <br />"Add additional pages if necessary. if 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 (3 <br />Annlication <br />