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DocuSlgn Envelope ID: EB99EC9B-ABB4-4858-B206-013A01AFF1FB OMB Approved No.: 1505-0270 U.S. DEPARTMENT Or, THE TREASURY Expiration Date: 10/31/2021 EMERGENCY RENTAL ASSISTANCE Eligible grantee name and address: DUNS Number: 083153247 City of Santa Ana Taxpayer identification Number: 956000785 20 Civic Center Plaza Assistance Listing Number and Title: 21.023-Emergency Rental Assistance Santa Ana, California, 92701-0000 Program Section 3201(a) of the American Rescue Plan Act of 2021, Pub, L. No. 117-2 (March 11, 2021), authorizes the Department of the Treasury ("Treasury") to make payments to certain eligible grantees to be used to provide emergency rental assistance. The eligible grantee hereby agrees, as a condition to receiving such payment from Treasury, to the terms attached hereto. --nocualgned by, t�VtS�iI W K1 d'" Authorized Representative Signature (above) [To be signed by chief'executive ofcer tf recipient is a local government.] Authorized Representative Name: Authorized Representative Title: Date Signed: U.S. Department of the Treasury: Nance o£Autholri=A Ytelveaenta[ive Iacch Lelbeniuff Title: Counselor to the Secradary Date: 5/13/2021 Kristine Ridge City Manager 5/10/2021 PAPERWORKREDUCTION ACT NOTICE: The Information collected will beused for the U.S. Crovermnent to process requests for support The estimated burden associated with this collection of information is 15 urinates per response. Comments concerning the accuracy of tills brvdon estimate and suggestions for reducing this burden should be directed to the Office 0fPdvacy, Transparency and Records, Department of the Treasury, 1500 Pennsylvania Ave., N.W., Washington, D.C. 20220. DO NOT send the form to this address. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid control number assigned by Olv1E. PRIVACY ACT STATEMENT AUTHORITY:Solicitatlon of this information Is authorized by the American Rescue Plan Act of 2021, Title III, Pub. L. No. 117-2. PURPOSE:Treasury is required by the American RescuoPlanAct of 2021 to identify eligible granteerdreclpients to provide emergencyrental assistaaceto individuals who qualify forrelief underthe Act. Eligible granteesheciplents are state, Icon[, and territorial govenanonts which identify households requiring relief according to requirernants contained in fire Act. Treasury maintains contact information for authorized representatives and contact persons for the purpose of communicating with eligible grantees regarding issues related to implemontahon of the Act. ROUTW E USES:The infrmation you furnish may be shared in accordance with the routine uses outlined in the Treasury's system of records notice, Treasury .017 - Corrosis ndence and Contact Information, which can be found at 81 FR 78266 (Nov. 7, 2016). DISCLOSURE: Disclosure of this information to Treasury is required in order to comply with tiro requiremetxts the American Rescue Plan Act of 2021. Disclosure of this information is voluntary, however, grantecalreciplents that do not disclose contact information will bearable to communicate with Treasury on issues related to their obligations under the Act and this may affect the status of their award.