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Impacted Tenants List (Exhibit A) <br />This List will become Exhibit A of the Grant Agieemenl ilia t you will enter into will? the City of Santa Ana, <br />Households with a Housing Choicr-. Voucher, also Known as Serlion 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 quality on this list. Please ensure you have. 1) a signed copy of the <br />Lease Agreement verifying occupancy for all lenanis on the Impacted Tenants Lis? for whom you are <br />seeking assistance: 2) documenlation on file for all tenants oil 0)e impacted Tenants List that <br />demonstrate iliat the tenaol has Been impacted by Coronavirus and have lost Jobs, had their work hours <br />reduced, ar have experienced a loss of income due to the economic or health impacts of Coronavirus and <br />who have been unable to nlainlain Iheirrent payments under their, lease agreements. Insufticient or <br />missing documentation may cause a delay in processing or, in some cases, a denial of the applicallon, <br />Additional docomentalion niay be requested during the review of your npplication. I hereby ahesl thal Ilia <br />Impacled Tenanis listed below will be released from any remaining obligation forany rent arrears owed <br />(20%) followingMillen I by the City of Santa Ana (80%). <br />Property Name; <br />Property Address: <br />Tax ID for Payment; <br />River House Apartments <br />211'I W. 1711' Street Santa <br />85-3099613 <br />Ana, CA 92706 <br />Full Rlatne of Tenant <br />Total Amount <br />(cis stated qn the Lease) <br />Address of Tenant's Rental Unit <br />of Rent Arrears <br />Juan Jarobr <br />21 11 W. 17ih Street Al <br />-$2,0001.15 <br />Alrna Davilla Rosale <br />_ <br />21 11 W. 17i" Street A4 <br />- <br />$3 830 65 <br />�Aldo Launa, <br />�_ <br />—_. to ,.. <br />2111 W 17 _Street G --� <br />323.73 <br />Miriam Kilduff <br />- _-- <br />2111 W.'171" Street E31 _ <br />�$LQ i <br />Lauren Sierra <br />21 I 1 W, 17°i Street E32 <br />- _ ----- <br />2111 W, IV' Street E38 <br />8 025,40 <br />Yuuana Guzman <br />7J4.00 <br />Steven4Sfoker <br />2111 W, 171h Street G7 <br />j 33,32_8:38 <br />fYctzell Avalos _ <br />_ <br />2111 W, 17l"-Street G27 <br />p2,985,23 <br />Miguel Maya ._._ � <br />2'i'l l W. 17ih Street H5 �— <br />-: ---- <br />I� $3,Z370.Fi5 <br />Maritza Riv as <br />,i, <br />2111 W. 17 Street_J6 <br />$2,458.88 <br />_ _ <br />Gabriela Gomez <br />2'1Ill W.y17°' Street G25 ---I__ <br />$2,689.23 <br />- <br />— <br />I <br />� <br />i <br />fatal Amount of Assistance�l <br />Requested <br />CCCs-�ci , <br />`Add 1I'I' I <br />accr Iona pages If necessary. If you have mfdhple properties and you are unable to <br />accept payment on behalf of all of thorn, please list each property separately and provide the <br />name of the properly at the lop of each list. <br />Coronavirus Emergency Rental Relief fund for Landlords Page 3 <br />Application <br />