CATHOLIC CHARITIES OF ORANGE COUNTY (7)

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DocuSign Envelope to: EB99EC9B-ABB4-4858-B206-013A01AFF1FB OMB Approved No.: 1505-0270 U.S. DEPARTMENT OF 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 Centel' 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. —noauatdned by: Authorized Representative signature (above) [To be signed by chiefexecutive officer ifrecipient is a local government] Authorized Representative Name: Authorized Representative Title: Date Signed: U.S. Department of the Treasury: Name of Authorized Representative: Jacob Leibenluft Tide: Counselor to the Secretary Date: 5fl3 2021 Kristine Ridge City Manager 3/10/2021 PAPERWORK REDUCTION ACT NOTICE: The information collected will be used far the U.S, Government to process requests forsupport. The estimated burden associated with this collection of information is l5 minutes per response. Comments concerning the accuracy ofthis burden estimate and suggestions for reducing this burden should be directed to the Office of Privacy, 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 requited to respond to, a collection of information unless it displays a valid control number assigned by OMB. PRIVACY ACT STATEMENT AUT IORITY:Solicitalion of this information is authorized by the American Rescue Plan Act of2021, Title 111, Pub. L. No. 117-2. PURPOSE;Trcasury is required by the American Rescue Plan Act of2021 to identify eligible gramcce/recipients to provide emergency rental assistance to individuals who qualify for relief under the Act. Eligible gmntees/mcipients are slate, local, and territorial governments which identify households requiring relief according to requirements contained in the Act. Treasury maintains contact information for authorized representatives and contact persons for the propose of communicating with eligible grantees regarding issues related to implementation of the Act. ROUTINE USES:The information you Rtmish may be shared in accordance with the routine uses outlined in the Treasury's system of records nolice, Treasury .017 - Conespondence and Contact Information, which can be found at 81 FR 78266 (Nov. 7, 2016). DISCLOSURE: Disclosure of this infommtion to Treasury is required in order to comply with the requirements the American Rescue Plan Act of2021. Disclosure ofthis information is voluntary, however, gmnlees/mcipienls that do not disclose contact information will be unable to communicate with Treasury on issues related to their obligations tinder the Act and this may affect the status of their award.