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22-UP�wo4 <br /> 28 of 28 <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-8) Initial,award disbursement: <br /> Administrative Entity/Contracting Agency Name <br /> Large City/Cfty of Santa Ana, Community Development Agency <br /> Administrative Entlty/Contracting Agency Business Address <br /> 20 Givic tenter Pleza, Santa Aria, M-25, CA.92701 <br /> contract Manager Name <br /> Terri Eggers <br /> Contract Manciger Email Address <br /> teggers@santa-ana.org <br /> Contract Manager phone Number <br /> 714-647-537$ <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 BCSH,in order to reduce the amount of <br /> paperwork needed to process your HHAP-3 award, HCFG is offering the opportunity to use the <br /> Tax ID Farm (Government Taxpayer ID Form for governmental entities or STD 204 Form for non- <br /> governmental entities) and/or Authorized Signatory Farm currently on file with FICFC for <br /> HHAP-3 award disbursements. You may revoke these authorizations by submitting an <br /> updated Tax 10 Form or Authorized Signatory Form to hhap0bcsh ca.gov. <br /> Select one- <br /> 0 The information on the Tax ID Foram 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 /> Cl(have included a new Tax ID Form for the iniffol HHAP-3 award disbursement <br /> -Select one: <br /> [21 The information on the most recent Authorized Signatory Form on file with HCFC is <br /> -accurate, and I am authorizing HCFC to use the form on file for HHAP-3 <br /> C1 I have included a new authorized.signatory form for HHAP-3 <br /> CERTIFICATION <br /> I certify that the signature below Is authoriized to sign for all applicable documents for the H H A P 4 grant <br /> on behalf of the Eligible Applicant.Jurisdiction listed above. <br /> Kristine Ridge, City Manager <br /> Name and Title of Authorized Representative <br /> —.- � 9/16/21 <br /> $ignature of Authorized Representative Date <br /> HHAP-3 Agreemegt to Apply 4 <br /> 16 —200 5/19/2026 <br /> Inifini <br />