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City of Santa Ana <br /> 22-i- 4JQTo� <br /> Page 26 of 26 <br /> HHAP-3 GRANTEE AWARD DISBURSEMENT INFORMATION <br /> ALL APPLiCANTs: <br /> Instructions, Please fill out the information below, which is needed to process your HHAP Round <br /> 3 (HHAP-3) Initial award disbursement: <br /> Administrative Entity/Contracting Agency Name <br /> t arge City/City of Santa Ann, Community Development Agency <br /> Administrative.Entity/Contracting Agency Business Address <br /> 20 Civic Center Plaza, Santa Ana, M-26, CA 92701 <br /> Contract Manager Name <br /> Terri Eggers <br /> Contrac-t Manager Email Address <br /> teggersfga santa-ana.org <br /> Contract Manager Phone Number <br /> 714-647-5378 <br /> Award Check Mailing Address (Include "Attention to," It applicable) <br /> City of Santa Ana <br /> Community Development Agency, 20 Civic Center Plaza, M-25, Santa Ana, CA.92701 <br /> For grantees who have previously contracted with BOSH, in order to reduce the amount of <br /> paperwork needed to process your HHAr-a Aware,., HCFC Is offering the opportunity to use the <br /> 'fax ID Farris (Govern'rrment Taxpayer ID Farm for governmental entities or STIQ 204 Form for non- <br /> governmental entities-) and/or Authorized.Signatory. Form currently on file with HCFC for <br /> HHAPY3 award disbursements.You may revoke these authorizations by submitfing an <br /> updated Tax ID Form or Authorized Sigrfatory Form to hhap@bcsh.ca.gov. <br /> I <br /> Select one: <br /> OThe Information on the Tax ID Form used for the HHAP-2 award disbursement is accurate, <br /> and I am authorizing HCFC to use the previously submitted form for the HHAP-3 Initial <br /> award disbursement <br /> El I have.Included a new Tax ID Form for the initial HHAP-3 award disbursement <br /> Select one: <br /> 0The Information on the most recent Authorized'Signatory Farm on file with HCFC Is <br /> accurate, and I.am authorizing HCFC to use the form on file for HHAP-3 <br /> CI I have included a new authorized signatory fora for HHAP-3 <br /> CERTIFICATION <br /> I certify that the signature*below is authorized to sign far all applicable documents for the HHAP-3 grant <br /> on behalf of the Eligible Applicant Jurisdiction listed above. <br /> Kristine Ridge, City Manager <br /> Name and Title of Authorized Representative <br /> 9116/21 <br /> Signature. of Authorized Representative Bate <br /> HHAP-3 Agreement to Apply 4 <br /> i y oun i 16 -- 170 5/19/2026 <br /> InithAl <br />