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Impacted Tenants List (Exhibit Al <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 Mousing Choice Voucher, also known as Section a. 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 lc 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) docurpenlation on Me for all tenants on the Impacted Tenants List that <br />demonstrate that the tenant has been impacted by Coronavirus and have lostjobs, had their work hours <br />reduced, orhave 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 listod below will be released from any remaining obligation for any rent arrears owed <br />(20%) following payment by the City of Santa Ana (80%). <br />Property Name: <br />Property Address; <br />Tax ID for Payment: <br />River House Apartments <br />2111 W. 17th Street Santa <br />85-3099613 <br />_ Nmnnr hi Ah „�., aw <br />Ana, CA 92706 <br />Full Name of Tenant <br />Total Amount <br />(as stated on the Lease) <br />Address of Tenant's Rental Unit <br />of Rent Arrears <br />— <br />- ---- - - --- <br />Owed <br />Maria Carlos <br />-... — <br />2111 W. 1711, Street A6 <br />$17�5.00 <br />Livingston De--- <br />Vaught ------------- <br />2111 W 1711, Street A24 <br />$5562 39 <br />Adele Bur o <br />------cJ- —s ___.__ <br />1h <br />21'1'I W. 17 Street C22 <br />$1720.00 <br />Sacramento Rodriquez <br />- - - J _ <br />2111 W. 17t11 Street C33 <br />-- <br />- <br />$1740.00 <br />Jose Ariaga- -- <br />..2111 W. 171" Street C35 <br />$1855,00 <br />Mercecles Zeped_a <br />2111 W. 1711' Street D31 <br />$1855,00 <br />I Marbella Salgado- <br />— <br />—- Martinez <br />—._----_-__._,_------ <br />2111 W. 17u' Street D32 <br />$1740.00 <br />Sindy Godinez Cerpa <br />2111 W, 17°, Street E25 <br />$1567.06 <br />Karla Mazariegos <br />2111 W, 17t11 Street G28 <br />$1830.UU <br />i Sara Orellano <br />2111 W, 17th Street H23 <br />Rosa Lineras <br />2111 W. 17t11 Street J23 <br />— <br />$1525.00 <br />m <br />Total Amount of Assistance <br />_Requested ___----- _1 <br />4.._.1L�-I`0,gS <br />acfmnurrul puyes a necessary. a you nave Miliple properties and you are unable to __.. <br />Coronavirus Emergency Rental Relief Fund for Landlords Pagel 3 <br />Application <br />