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HomeMy WebLinkAboutSTRAIGHT TALK, INC. -2007 INSURANCE ON F1l.E ~,r~EXPlRES A-2007-143 7-/-0g ~1~;?\J~~\L GRANT AGREEMENT FOR ACQUISITION OF AN 8 BEDROOM HOME O'.COA (2) (HOUSING OPPORTUNITIES FOR PERSONS WITH AIDS) (.Jc>l-w' Malooey) (24 cm Part 574) THE CITY OF SANTA ANA, CALIFORNIA, a charter city and municipal corporation, duly organized and existing under the Constitution and laws of the State of California ("City"), and STRAIGHT TALK, INC., a California non-profit public benefit corporation ("Developer"), in furtherance of the regulations issued by the U.S. Department of Housing and Urban Development set forth in 24 CFR Part 574 (the "HOPWA Regulations"), hereby agree as follows: A. City is responsible funds (" HOP~JA Funds" ) Department of Housing Housing Opportunities Program"); and for administration of the use of certain made available by the United States and Urban Development ("HUD") under the for Persons With AIDS Program (the "HOPWA B. Developer intends to acquire the property at 13441 Golden West Street in the City of Westminister (the "Property") and use the Property to provide housing for persons with acquired immunodeficiency syndrome ("AIDS") and related diseases; and C. City has determined that Developer and the Property are eligible to receive funds made available by HUD pursuant to the HOPWA Program for the purpose of purchasing the home; and D. The parties mutually desire to comply with all applicable HOPWA Regulations. NOW, THEREFORE, City agrees to make a grant of HOPWA Funds to Developer in the amount of $ 535,000 (the "Grant"), subject to the following terms and conditions: 1. Use of Grant. 24 cm 574.300Cbl (3). The Grant shall be used exclusively for the payment of a portion of the acquisition costs associated with the purchase of the home. Grant funds shall be used as follows: a. Acquisition of Property. The HOPWA grant shall be used for the acquisition of the Property (see Legal Description of Property attached hereto as Attachment No.1). Funds shall be disbursed in the amounts approved by City. All disbursements shall be made subsequent to Developer taking title to the Property. These approved expenses are attached in the estimated Escrow Closing Statement (Attachment No.2). b. Schedule. Developer shall close escrow' on the Property not later than 60 days after execution of this Agreement. This schedule may be modified with the consent of the Deputy City Straight Talk Development Agreemant 7/18/2007 1 Manager for Development Services or his/her designee. c. Reserved. d. Inspections. Developer shall inspect the Property to assure that it meets Housing Quality Standards and conforms with the applicable federal, state and/or local requirements and this Agreement. The City reserves the right to inspect the Property at any time during the period of time set forth in Section 3 of this Agreement. Such inspection shall occur at least annually during said period of time. 2. Disbursement of Funds. 24 CFR 92.504(c) (10). Developer shall not request disbursement of any portion of the Grant until the funds are needed to pay eligible costs. The total amount to be placed into escrow shall be limited to the amount needed. The City shall have the right to disapprove any request if the City determines the request is for an ineligible item or is otherwise not in compliance with or is inconsistent with this Agreement. Grant proceeds used for actual costs shall be placed in an non- interest bearing escrow account with united States Escrow or at such other institution as City requires in compliance with federal regulations found at 24 CFR 511 (the "Escrow Account"). Upon wri tten request of Developer, City will request disbursement of funds from the escrow account. All funds disbursed to Developer shall be received by Developer in trust and Developer agrees that the same shall be used only for the payment of these items contemplated by the particular disbursement. 3. Minimum Use Period. 24 CFR 574.310 (c) . Developer agrees that the Property will be used as a facility to provide housing or assistance for individuals with AIDS or related diseases for a period of not less than 10 years. 4. Eliaible Occupants. 24 CFR 574.3. 24 CFR 573.310(e). Occupancy of the Property shall be limited to Eligible Persons and their Families. For the purpose of this Agreement: a. related Family. "Eligible Person" shall mean a person with AIDS or a disease who is a low-income individual, and the person's b. "family" shall mean a household composed of one or two related persons. The term "Family" also includes a person who is determined to be important to the care or well-being of the Eligible Person, and the surviving member or members of any family described in this paragraph who were living in a dwelling unit on the Property with the person with AIDS at the time of his or her death. Straight Talk Development Agreement 7/18/2007 2 c. "Low- Income Individual" mean any individual or family whose income does not exceed 50% of the median income for the area, as determined by HUD. If at any time the property cannot be filled with individuals or families at or below the 50% of the median income the criteria may be move to 80% of the median income with pre approval of the City of Santa Ana. Notwithstanding the foregoing, the surviving member or members of a Family who were living in a dwelling unit on the Property at the time of the death of the person with AIDS may continue tc occupy the Property for a period of up to 60 days following the death of the person with AIDS. 5. Rental Pavments. 24 CFR 574.310Cdl, 24 CFR 574.430. The rent charged by Developer for any dwelling unit wi thin the Property shall be the higher of: a. 30% of the Family's monthly adjusted income (adjustment factors include the age of the individual, medical expenses, size of family and child care expenses and are described in detail in 24 CFR 813-1020); or b. 10% of the Family's monthly gross income; or c. If the Family is receiving payments from welfare assistance from a public agency and a part of the payments, adjusted in accordance with the Family's actual housing costs, is specifically designated by the agency to meet the Family's housing costs, the portion of the payments that is so designated. Except Eligible Funds. for rent, Developer shall Person for any housing or not charge any fee of any services provided with HOPWA 6. Supportive Services. 24 CFR 574.310Cal. Developer, either itself or through qualified service providers in the area, shall make appropriate supportive services available to the occupants of the Property. Supportive social services include but are not limited to, health, mental health, assessment, permanent housing placement, drug and alcohol abuse treatment and counseling, personal assistance, nutritional services, intensive care when required, and assistance in gaining access to local, State, and Federal government benefits and services, except that health services may only be provided to individuals with acquired immunodeficiency syndrome or related diseases and not to family members of these individuals. For any individual with AIDS or a related disease who requires more intensive care than can be provided at the Property, Developer shall locate a care provider who can appropriately care for the individual and refer the individual to that care provider. Straight Talk Development Agreement 7/18/2007 3 7. Housina Oualitv Standards. 24 CFR 574.310Ibl. The Property shall be developed to comply with the housing quali ty standards set forth in 24 CFR 574.310 (bi, a copy of which is attached to this Agreement as Attachment No.3. Developer shall maintain the Property in compliance with the housing quality standards for the period set forth in section 3 of this Agreement. 8. Other Proaram Reauirements. Developer shall comply with all applicable federal set forth in Subpart E, F and G of the HOPWA including the following: requirements regulations, a. Confidentiality. 24 CFR 574.440. Developer shall ensure the confidentiality of the name individual assisted under the HOPWA Program and any information regarding individuals receiving assistance. of any other b. Certification of Consistency with Consolidated Plan of the City of Westminister. Developer must provide proof to the City of Santa Ana that the Project is consistent with the Consolidated Plan of the city in which the Project is being developed. Developer has provided such proof, attached heretn and incorporated herein as Attachment No.6. c. Equal Opportunity and Fair Housinq. 24 CFR 574.600. (1) Civil Riqhts, Fair Housinq, and Aqe Discrimination Acts Assurances: During the performance of this Agreement, Developer assures that no otherwise qualified person shall be excluded from participation or employment, denied program benefits, or be subjected to discrimination based on race, color, national origin, familial status, sex, age, handicap, religion, or religious preference, under any program or acti vi ty funded by this Agreement, as required by Title VI of the Civil Rights Act of 1964 942 O.S.C. 2000d), the Fair Housing Act (42 O.S.C. 3601-19) and the Age Discrimination Act of 1975 (42 O.S.C. 6101-07), and all implementing regulations. (2) Reserved. (3) MBE/WBE Affirmative Action Outreach Proqram. Developer hereby agrees to comply with the City's minority and women business outreach program in accordance with 24 CFR 574.600(d) (4 ) Affirmative Outreach. Developer shail adopt straight Talk Development Agreement 7/18/2007 4 procedures to ensure that all persons who qualify for assistance under the HOPWA Program, regardless of their race, color, religion, sex, age, national origin, familial status, or handicap, know of the availability of the HOPWA Program, including facilities and services accessible to persons with a handicap, and maintain evidence of implementation of the procedures. (5) Disability Pequirements. Developer shall not discriminate against persons with AIDS or related diseases based on an additional disability of such persons in violation of the Fair Housing Act or section 504 of the Rehabilitation Act of 1973. Developer also shall comply with the reasonable modification requirements of the Fair Housing Act, the reasonable accommodation requirements of the Fair Housing Act and section 504 of the Pehabilitation Act of 1973 and the Americans with Disabilities Act, and implementing regulations. d. Waoe Pates. 24 CFP 574.655. The provisions of the Davis-Bacon Act (40 U.S.C. 276a-276a-5) do not apply to the development of the Property, unless Developer will be using HOPWA Funds in combination with funds from other Federal programs that are subject to the Act. e. Conflict of Interest. 24 CFP 574.625. No person who is an employee, agent, consultant, officer or elected or appointed official of the City of Santa Ana or of Developer, who exercises or has exercised any functions or responsibilities with respect to activities assisted with HOPWA Funds or who 'is in a position to participate in a decision making process or gain inside information with regard to these activities, may obtain a financial interest or benefit from this Agreement, or have an interest in any contract, subcontract or agreement with respect hereto, either for himself or herself or those with whom he or she has family or business ties, during his or her tenure or for one year thereafter. g. Debarment and Suspens ion. 24 CFR 574.620. Concurrently with the execution of this Agreement, Developer has completed and delivered to the City the Certificate Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion-- Lower Tier Covered Transactions, attached hereto as Attachment No. 4, as required by 24 CFR 574.620. h. Lobbying. 24 CFR 574.615. Concurrently with the execution of this Agreement, Developer has completed and delivered to the City the Certification Regarding Lobbying attached hereto as Attachment No.5, as required by 24 CFR 574.615. 1. Flood Insurance. 24 CFR 574.640. This Agreement is subject to the requirements of the Fluod Disaster Protection Act of 1973 (42 U. S.C. 4001 et seq.). No portion of the assistance provided under this Agreement is approved for acquisition, rehabilitation, or construction purposes as defined under Section Straight Talk Development Agreement 7/18/2007 5 31a) of said Act, for use in an area identified by the Federal Emergency Management Agency as having special flood hazards which is located in a community not then in compliance with the requirements for participation in the National Flood Insurance Program pursuant to Section 201 (d) of said Act. The use of any assistance provided under this Agreement for such acquisition, rehabilitation, or construction in such identitied areas in communities then participating in the National Flood Insurance Program shall be subject to the mandatory purchase of flood insurance requirements of Section 102(a) of said Act. j. Coastal Barriers. 24 CFR 574.645. This Agreement is subj ect to the Coastal Barrier Resources Act (16 U. S. C. 3501). No financial assistance under the HOPWA Program may be made available within the Coastal Barrier Resources System. The use of any assistance provided under this Agreement within the Coastal Barrier Resources System shall be grounds for immediate termination of this Agreement. 9. All-Risk and Liabilitv Insurance. Developer, and the subsequent Owner shall maintain, during the term of this Agreement, II) an all-risk property insurance policy insuring the Property in an amount equal to the full replacement value of the structures on the Property, and (2) a comprehensive general liability insurance policy with a $1,000,000 limit of liability. The all-risk policy shall name the City as loss payee and the liabili ty insurance po}j cy shall name the City as an additional insured. Each policy shall contain a statement of obligation on behalf of the insurance carrier to notify the City of any material change, cancellation or termination of coverage at least 30 days in advance of the effective date of such material change, cancellation or termination. Developer and/or any subsequent Ohmer shall deliver a copy of the certificate of insurance for each policy and the loss payee or additional insured endorsement, as the case may be, to the City at the execution of this agreement. Developer and any subsequent Owner of the Property shall annually deliver a copy of the certificate of insurance for each policy and the loss payee or additional insured endorsement, as the case may be, to the City, signed by an authorized agent of the insurance carrier and setting forth the general provisions of coverage. The copies of the certificate of insurance and endorsements shall be delivered to the City as follows: The City of Santa Ana 20 Civic Center Plaza Santa Ana, California 92702 Attention: Housing Authority Any certificate of insurance required by this Section 9 must be in a form, content and with an insurance company that is acceptable to the City in its sole discretion. Any insurance proceeds shall, to the extent applicable, be paid to Straight Talk Development Agreement 7/18/2007 6 the additional insured and, at the option of such additional insured, may be applied to any indebtedness owed to such insured or released for repair or rebui lding of the Property. Surplus insurance proceeds thereafter may be disbursed to the Developer. 10. Records and Reports. 24 CFR 92.504(c) (12). Developer shall prepare, maintain and submit to the City, as appropriate, the following records and reports: a. Annual Reports. Developer shall file with the City an Annual Report (herein referred to as the "Annual Report") within sixty (60) days following the end of each caJ endar year, commencing ,-'i th the end of the calendar year during which the acquisition is completed. The Annual Report shall include, and shall contain a certification with regard to, the rental rate and the income and family size of the occupants for each dwelling unit on the Property who have inhabited the Property during the previous calendar year. Developer shall obtain the income information required to be included in the Annual Report from the occupants of the Property. Any lease or other agreement that Developer requires occupants of the dwelling units on the Property to execute shall require the occupants to provide such income information upon the request of the Developer. The Annual Report shall contain a certification by Developer as to such olher information the Deputy City Manager for Development Services or his/her designee may reasonably require. (I) subcontractors above. Certifications given by contractors and (if any) given pursuant to Sections 8. g. and 8. h. , (2) Statement of income to Developer from tenants pursuant to Section 10.a., above. Developer shall retain all books and records relevant to this Agreement for a minimum of four years after the expiration of this Agreement and any and all amendments hereto, or for four years after the conclusion or resolution of any and all audits or litigation relevant to this Agreement, whichever is later. The City, the State, HUD, and/or their representatives shall have unrestricted reasonable access to all locations, books, and records for the purpose of monitoring, auditing, or otherwise examining said locations, books, and records with or without prior notice. If so directed by the City, the State or HUD upon termination of this Agreement, Developer shall cause all records, accounts, documentation and all other materials relevant to the Work to be delivered to the City, the State or HUD, as depository. c. Audi ts. Developer shall be subj ect to periodic audits pursuant to 24 CFR Part 45. Developer shall reasonably cooperate with City in performing such audit. Straight Talk Development Agreement 7/18/2007 7 11. Enforcement. 24 CFR 92.504(c) (13). This Agreement and all of its attachments, shall be enforceable by City in accordance with the terms hereof. Failure by Developer to comply with any material provision hereof shall constitute a breach. In the event of a breach, City shall provide written notice to Developer. City may terminate this Agreement in the event Developer fails to cure any such default within 30 days after notice, or such longer period if such default cannot reasonably be cured in 30 days and the Developer has commenced such cure within the 3D-day period and is diligently prosecuting the cure to completion, or in the event that Developer conveys the Property to a person who does not agree to assume the obligations of Developer under this Agreement. The foregoing provision does not apply to a transfer of the Property to HUD or to a transferee of HUD. 12. Attachments. Developer has reviewed and, if appropriate, agrees to execute and acknowledge the following documents in substantially the form as attached to this Agreement prior to receiving the Grant, and any other documents or instruments reasonably required by the City or a participating entity to complete the transaction contemplated herein: Attachment No. 1 Legal Description of the Property Attachment No. 2 Estimated Closing Statement Attachment No. 3 Certification Regarding Debarment Attachment No.4 Certification Regarding Lobbying Attachment No.5 Certification of Consistency with Consolidated Plan of the City of Westminister Attachment No. 6 Housing Quality Standards 13. Duration of this Agreement. This Agreement shall remain in effect for 10 years from the date of this Agreement and shall automatically terminate on the tenth anniversary of the date of this Agreement. [SIGNATURES ON FOLLOWING PAGE] Straight Talk Development Agreement 7/20/2007 8 IN WITNESS WHEREOF, the City and Developer have executed this Agreement on the date first stated above. ATTSST: ~- &:::;; ..P t(/. Patricia E. He ly Clerk of the CouncLl APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney By:&t~ [ ~ Lisa E. Storck Assistant City Attorney Straight Talk Development Agreement 7/18/2007 CITY OF SANTA ANA ~f}a_____ David N. Ream City Manager RECOMMENDED FOR APPROVAL: ~MlttH ~ tephen . Harding ~eputy ~ ty Manager for Development Services STRAIGHT TALK INC., A California N@2:,~ZLH ,o"pm",oo Bruce Robbins Executive Director 9 LEGAL DESCRIPTION All that certain real property situated in the County of Orange, State of California, described as follows: Lot 6 of Tract No. 2388, in the City of Westminster, County of Orange, State of California, as shown on a Map recorded in Book 77, Pages 39, 40 and 41 of Miscellaneous Maps, Records of Orange County, California. EXCEPT therefrom all oil, gas, minerals, and other hydrocarbon substances lying below the surface of said land, but with no right of surface entry, as provided in deeds of record. Assessor's Parcel Number: 203-482-36 Attachment No. I ~C""l"')J."I" ....1IIIIIIII "'I~<)C l..folON ~ O~ ""~"~T~~'''' BUYER:S~r.iaht Talk. Tn~. PROPERTY ADDRESS: 1~441 at'l'rt"'nWlll!l~ S~r..t. w..t:minllt:.r CA PROJECTED CLOSING DATE: oa/O"'007 New First Loan: S Rate: New Second Loan: S Rate: Current Annual Property T..,es; $ 6,414 Rat.: 1.250 FINA.'1CING CHARGES New First Loan OrlginlUlon fee/Points % $ Secondary Financing Orig. FeelPoints % S Prepaid Interest (First Loan) # Ooys_ S Prepaid Interest (SeeonaBly Financing) # Days_ $ lmpollrlds; - Propeny Taxes # \:lonth, _ $ . Insurance # Month,_ $ Processlngll.Jnderwriting Fe.. $ Document Preparation Fees $ AppraISal Fees $ Funding Feos $ Other Lender Fees (7i1o~ Strvic:o, fiood CortitiCatcel, ~IC.) $ ESCROW AND TITLE CHARGES Escrow Fee iii including any Sub-Escrow Fee $ Owner's Title Insurance Policy S Lender', Title Insurance Policy $ Dacumen: Preparation, Recording. NotllT)' & other Fees $ OTHER EXPENSES &: PRORA no~s Prorated Property Taxes # Da>.s _ $ Homeowners Dues # Da>, _ $ Tn,nsfer Tax (lfcharJlt.:1 II) Bll)'cr) Rllto (.'iU Sl,O(IO $ $ Buyer Brokeraie Fee S Annual Insurance Pr.miurn (excludlns fiood & eanhquake) S Horne Warranl, Program $ Wood-OestrD>ing Pest Inspection $ Other Ph;"ical Inspect]on Fees $ HOA Tran,fer andlor Move-In Fees $ Other $ $ TOTAL ESTIMATED EXPENSES 5 2.765 This estimate, based upon the above propo$~d pur~hase pri.:e, tvpe ~lf fln8l'lcl."1g and projec:t.:d elc/sing d!tc, has been prep.!l'ed to assist BU)'cr in c1)mpuling oosts. Amounts will vaI)' d~pcndjn.s upon diff~renccs betwe~n actual and ~stimf1ted I'tpair. t~lIlt may occur in the transaction, asse~smcnts. li~ru, jmpOU~d counts, charges by lenders. escrow c:cmpanies. title insurers and othor ser....ice pro. ,,'iders and other items, Not all liens may ).~t have betm identifie 'either BrQkl!f no gont arantee these figures represent the ~lulll. or onty. amount, L\.'ld che.rges. B)' signing be 1,1 ~uyer acknowl go . &u~r has rel!d, understL"'l.ds and recoived 0. cop>, ofthi~ Estimated Buyers CO!ts. Buyer ~ Stn1 b.t Talle %1>", Oate07/09/3007 Buyer Date Renl E'tate Broker 1 CalH"....h llrolc..,a I..c, ORE Lie, # 01291391 By (Agent) .. rraDlc ..:~1 ORE Lil,'l. # 0123~O"O Date Q7/09/2007 Address 180 .bale.., 1\ d Su t. 340 Cll)' J;e:rrtto8 State CA Zip 90703 Telephone (714) 904-3U3 Fax (714) 523-1924 E-mail fr&l1k1...,,,i8ao1.cQIlI The cop~rl,m: laWS of th. Unlt,d.:!'.le, (TItle 17 U.S. Code) forbId me ~uI'lOri.r:.c:I rl!~O(fuction r:I 1M1. rorm, or al'llllirtion NltoI', by phQtoec~y mlenl.',. Of any o\hI~ mun, ro.""", ',..'m,', """",t.!~" form",. CoPY"'" = 19;',:'" CAl60'INIA ASSOCIATION OF RMUORS~. I ,ALL RIGHTS ~ESE~VEO. THIS FORM tiA$ eeeN APPFlOVED By THI! CAl.IFORNIA ASSOCIATION OF REAI..TOflMl (CAR , ~C' REPA. S NiATIO~ IS MADE AS TO THE liGAL VAliDITY O~ AD!iQt,.'ACY OF ANY PROVISION IN ANY SPECIFIC TAANSACTION, A ReAl.. eSTATE. SA-O !II\ IS THE PERSON QUAlIFIEO TO AOVlS~ ON REAL ESTATE TRA~SACTIONS_ IF YOU OESIRE LEGAL OR TAX ADVICE, CQNSULT AN ,APPROPRIATE PROFESSIONAL. TI111 farm ;e, .\'.ilablll for u.. by the entire rell ..tale IndUltr"{, Ht r.ot inltnded to Identify till user I. . ReAl7"OR~. !=',EAL TOR~ I, a faglslere<j collectlve memDershlP mark wt'.lch may bf uled only ~ rnembln of th8 NATIONAL ASSOCIATiON 01= REAl. TORse wl\o subtcr.be to It 1 Codl Qf ilhl:::.e. ~S~I~~~~~ ~ SlRE t j. R~l ESTATE BU&I~ESS SERV:CES. INC. I I - I sub:J:1ill"/ of ttl. C.Mom:. As.sa=latiofl 01 REAl.. rORS'$ ~e...lewed by Date _ ,,,. i\'llIim fOI ~Ct;.. ~2' $olrlh Vl~ijAv':1Ue. LoOI Ana.I". Calltorni. 90020 t~UUh' ESC REVISED 0106 ~AOE 1 OP 1) ESTIMATED BUYER COSTS EBC GE 1 OF 1 .....""" Ag.nt: Fr.nk Sargl Phon" 1714) 104.3423 Pax: (7141523 .1921 Prepared ullng WINFonnsrl!> .oItwo.. B~oktr: A:I C.lifomi. Brokera;e, Inc. 180QO Stud,b.k., Rd Ste 260 C.~rltoa. CA 10703 ESTIMATED SUYER COSTS (C,A.R. Form EIC, R.vl..d 4101) DATE: 07/01/2007 g2SA1~2'S' PROJECTED PURCHASE PRICE: $ 600,000,00. % o Fixed or CAdjustoble 0 Interest Onl,' Tlrrn:_year, % o fixed or o Adjustoble 0 Interest Only Term:_years % If Rented, Current Monthly Rent $ __ ESTIMATED CREDITS Prorated Propert>' Taxel "D.ys.....1.l-$ Prorated Rents 1/ Oay,_$ Tonant Security Depo,it' $ Cre dit from Seller $ Other $ Total Estimated Credit. $ l,10S ESTIMATED CASH NEEDED TO CLOSE PurchascPrice S son.ono LESS Total Loans Down Po>," ent PLUS Total Estimated Expe"ses LESS Totol Estimated Ctedits 6 Oil LESS Jnitial Deposits Ell, C..h Needed to Clost E",ow S06 500. .on.~ 2.745 + ~ 10 cCln $ !'iQ1 ,.'Q non ESTIMATED MONTHL Y P,\ YMEI\TS New First Loan' $ , SeconaBly Financing' $ ~ New Propeny Taxes $ [nsurance (ex. flood & eQrlhqua.\.:.e) $ _ Mortgage Insurance $ ., Homeowners Dues S i' Mello Roos $ 'I O1her S Total Estlmnted Payment $ 70. 001 , Buyer is aware that withrciud to adjustable rate lo,,"s, the monthly payments may increas.e at various times over I the life of the Joan. Bu;,er should .onfunl directly with I lenders aUlenns and condition. of said loans. i ~,~ ATTACHMENT No. 2 ATT.'\CHMENT NO. 3 CERTItICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION - LOWER TIER COVERED TRANSACTIONS 24 CtR Part 24, Appendix B Instructions for Certification 1. By signing and submitting this lower tier participant is providing below. proposal, the prospective the certification set out 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to whom this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of charged circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineli gibili ty and Voluntary Exclusion Lower Tier Covered Transaction," without modification, In all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered Straight Talk Development Agreement 7/1B/2007 12 transaction that it is not debarred, suspended, ineligibLe, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to check the Nonprocurement List (Tel #). 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except tor transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to pther remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions 11) The prospective 10'.-ier tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (2) Where certify to prospective proposal. the prospective lower tier any of the statements in participant shall attach participant lS unable to this certification, such an explanation to this Dated: -,(I'if(01 DEVELOPER - Straight Talk, Inc. By: kup ~ Bruce Roobins Straight Talk Development Agreement 7/18/2007 13 ATTACHMENT NO. 4 CERTIFICATION REGARDING LOBBYING 24 CFR Part 87, Appendix A Certification for Contract, Grants, Loans and Cooperative Agreements The undersigned certifies, knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection wi th the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. to the best of his or her (2) If any funds other than Federal appropriated funds have been paid or will be pajd to any person for influencing or attempting to influence an officer of employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress, in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbyjng," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub awards at all tiers (including subcontracts, sub grants, and contracts under grants, loans, and cooperative agreements) and that all sub recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. P.ny person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Dated: 1/[:6(01 ::"CCOCO~~:,~j~'j, 4 Bruce Robbins ATTACHMENT NO. 5 Inc. Straight Talk Development Agreement 7/18/2007 14 Q1 itll of ~cstmiustcr CIVIC CENTER 8200 WESTMINSTER BOULEVARD WESTMINSTER, CALIFORNIA 92683 (714) 898-3311 Certification of Consistency with the Consolidated Plan U.S. Department of Housing and Urban Development MARGIE L. RICE MAYOR KERMIT D. MARSH MAYOR PRO TEM FRANK G. FRY COUNCIL MEMBER ANDY QUACH COUNCIL MEMBER TRITA COUNCIL M EM BER RAMON SILVER CITY MANAGER OMB Approval No. 2SQ6..0112 (Exp. 3f31f2010) I certify thai the proposed activities/projects in tbe applicalion are consistent with the jurisdiction's currenl, approved Consolidated Plan. (Type or clearly print the following information:) Applicant Name: Project Name: LocalioD of the Project; Name of the Federal Program to which the applicanl is applying: Name of Certifying Jurisdiction: Certifying Official of the Jurisdiclion Name: Signature: Straight Talk Clinic, Inc. Stable Ground Residencyl Straight T elk Clinic, Inc. 13441 Gokienwest Street Westminster, CA 92683-2656 Housing Opportunnies for Persons with Aids (HOPWA) City of Westminster Ramon Silver Title: cny Manager (7/a-- <l2 ~v1, Dale: , -//~07 . Attachment No. 5 Inspection Form Housing Choice Voucher Program U.S. Department of Housing and Urban Development Office of Public and Indian Housing OMB Approval No. 2577-0169 (expo 9/3012002) Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information, This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMS control numbeL This collection of information is authorized under Section a of the U.S. Housing Act of 1937 (42 U.S.C. 14371). The information is used to determine if a unit meets the housing Quality standards of the section 8 rental assistance program. PHA Tenant In Number Date of Request (mmfdd/yyyy) Inspector Neighborhood/Census Tract A. General Information Street Address of Inspected Unit City l~unty Name of Family Current Street Address of Family City Number of Children in Family Under 6 Name of Owner or Agent Authorized to Lease Unit Inspected Address of Owner or Agent S. Summary Decision on the Unit (to be completed after the form has been filled in) Housing QuaUty Standard Pass or Fail o 1. Fail If there are any checks under the column headed "Fail" the unit fails the minimum housing quality standards. Discuss with the owner the repairs noted that would be necessary to bring the unit up to the standard. o 2. Inconclusive If there are no checks under the column headed "Fail" and there are checks under the column headed "Inconclusive," obtain addi. tional information necessary for a decision (question owner or tenant as indicated in the item instructions given in this checklist). Once additional information is obtained, change the rating for the item and record the date of verification at the far right of the form. o 3. Pass If neither (1) nor (2) above is checked, the unit passes the minimum housing QuaJity standards. Any additional conditions described in the right hand column of the form should serve to (a) establish the precondition of the unit, (b) indicate possible additional areas to negotiate with the owner, (c) aid in assessing the reasonableness of the rent of the unit, and (d) aid the tenant in deciding among possible units to be rented. The tenantis responsible for deciding whether he or she finds these conditions acceptable. C--- -l UnltSize: Count the number of bedrooms for purposes of the FMR or Payment Standard. Record in the box provided. L ~ Year Constructed: Enter from LlOe 5 of the Request for Tenancy Approval form. Record in the box provided. [ ~ Number of Sleeping Rooms: Count the number of rooms which could be used for sleeping, as identified on the checklist. Record in the box provided. Date last Inspection (mmlddJyyyy) Dale of Inspection (mmldd/yyyy) Type of Inspection Project Number o Initial 0 Special 0 Reinspection I Stale [ Zip Current Telephone offamfly Housing Type (check as appropriate) o Singla Family Detachad o Duplex or Two Family o Row House or Town House o D D D Congregata D D o D D Olhar:(Specily) Low Rise: 3,4 Stories, Including Garden Apartment High Rise; 5 or More Stories Manufactured Home Cooperative Independent Group Residence Single Room Occupancy Shared Housing C. How to Fill Out Thts Ch&cktlst Complete the checklist on the unit to be occupied (or currently occupied) by the tenant. Proceeed through the inspection as follows: Area Checklist Category room by room 1_ Living Room 2. Kitchen 3. Bathroom 4. All Other Rooms Used for Living 5. All Secondary Rooms Not Used for Living basement or utility room 6. Heating & Plumbing outside 7. Building Exterior overall 8. General Health & Safety Each part of the checklist will be accompanied by an explanation of the item to be inspected. Important: For each item numbered on the checklist, check one box only {e.g.. check one box only for item 1.4 "Security,~in the Living Room.) In the space to the right of the description of the item, if the decision on the item is: "FaW write what repairs are necessary; If "InconchJsive~ write in details. Also, if MPa$sM but there are some conditions present that need to be brought to the attention of the owner or the tenant, write these in the space to the right. If it is an annual inspection, record to the right of the form any repairs made since the last inspection. If possible, record reason for repair (e.g., ordinary maintenance, tenant damage). If it is a complaint inspection, fill out only those checklist items for which complaint is lodged. Determine, if possible, tenant or owner cause. Once the checklist has been completed, return to Part B (Summary Decision on the Unit). Previous editions are obsolete form HUD.525BO--A (9//2000) ref Handbook 7420.8 Page 1 of 20 Attachment No. 6 1. Living Room 1.1 Living Room Present Note: If the unit is an efficiency apartment, consider the living room present. 1.2 Electrictty In order to qualify. the outlets must be present and properly installed in the baseboard, wall or floor of the room. Do not count a single duplex receptacle as two outlets, i.e., there must be two of these in the room, or one of these plus a permanently installed ceiling or wall light fixture. Both the outlets and/or the light must be working. Usually, a room will have sufficient lights or electrical appliances plugged into oullets to determine workability. Be sure light fixture does not fail just because the bulb is burned out. Do not count any of the following items or fixtures as outlets/fixtures: Table or floor lamps (these are not permanent light fixtures); ceiling lamps plugged into socket; extension cords. If the electric service to the unit has been temporarily turned off check "Inconclusive." Contact owner or manager after inspection to verify that electricity functions properly when service is turned on. Record this infonmation on the checklist. 1.3 Electrical Hazards Examples of what this means: broken wiring; noninsulated wiring; frayed wiring; improper types of wiring, connections or insulation; wires lying in or located near standing water or other unsafe places; light fixture hanging from electric wiring wtlhout other finm support or fixture; missing cover plates on switches or outlets; badly cracked outlets; exposed fuse box connections; overloaded circuits evi- denced by frequently "blown" fuses (ask the tenant). Check ~lnconclusive" if you are uncertain about severity of the problem and seek expert advice. 1. 4 Security "Accessible to outsideN means: doors open to the outside or to a common public hall; windows accessible from the outside (e.g. basement and first floor); windows or doors leading onto a fire escape, porch or other outside place that can be reached from the ground. "Lockable" means: the window or door has a properly working lock, or is nailed shut, or the window is not designed to be opened. A storm window lock that is working properly is acceptable. Windows that are nailed shut are acceptable only if these windows are not needed for ventilation or as an alternate exit in case of fire. 1.5 Window Condition Rate the windows in the room (including windows in doors). "Severe deteriorationN means that the window no longer has the capacity to keep out the wind and the rain or is a cutting hazard. Examples are: missing or broken-out panes; dangerously loose cracked panes; windows that will not close; windows that, when closed, do not form a reasonably tight seal. If more than one window in the room is in this condition, give details in the space provided on the right of the form. If there is only "moderate deterioration" of the windows the item should "Pass.- "Moderate deterioration" means windows which are reasonably weafher-tight, but show evidence of some aging, abuse, or lack of repair. Signs of deterioration are: minor crack in window pane; splintered sill; Signs of some minor rotting in the window frame orthe window itself; window panes loose because of missing window pulty. Also for deleriorated and peeling paint see 1.9. If more than one window is in this condition, give details in the space provided on the right of the form. Previous editions are obsolete Page 2 of 20 1.0 Celllng C.ondltlon "Unsound or hazardous" means the presence of such serious de- fects that either a potential exists for structural collapse or that large cracks or holes allow significant drafts to enter the unit. The condition includes: severe bulging or buckling; large holes; missing parts; falling or in danger of falling loose surface materials (other than paper or paint). Pass ceilings that are basically sound but have some nonhazardous defects, including: small holes or cracks; missing or broken ceiling tiles; water stains; soiled surfaces; unpainted surfaces; peeling paint (for peeling paint see item 1.9). 1.7 Wall Condition "Unsound or hazardous" includes: serious defects such that the structural safety of the building is threatened, such as severe buckling, bulging or leaning; damaged or loose structural members; large holes; air infiltration. Pass walls that are basically sound but have some nonhazardous defects, including: small or shallow holes; cracks; loose or missing parts; unpainted surfaces; peeling paint (for paeling paint see item 1.9). 1.8 Floor Condition "Unsound or hazardous" means the presence of such serious de- fects that a potential exists for structural collapse or other threats to safety (e.g., tripping) or large cracks or hoies allow substantial drafts from below the floor. The condition includes: severe buckling or major movements under walking stress; damaged or missing parts. Pass floors that are basically sound but have some nonhazardous defects, Including: heavily worn or damaged floor surface (for ex- ample, scratches or gouges in surface, missing portions of tile or linoleum, previous water damage). If there is a floor covering, also note the condition, especially if badly worn or soiled. llthere is a floor covering, including paint or sealant, also note the conditions, spe- cially if badly worn, soiled or peeling (for peeling paint, see 1.9). 1.9 Lead-Based Paint Housina Choice Voucher Units If the unit was built January 1, 1978, or after, no child under age six will occupy or currently occupies it, is a O-BR, eiderly or handicapped unit with no children under age six on the lease or expected, has been certified lead.. based paint free by a certified lead-based paint inspector (no lead-based paint present or no lead-based paint present after removal of lead-based paint.), check NA and do not inspect painted surfaces. This requirement applies to all painted surfaces (building compo- nents) within the unit. (Do not include tenant belongings). Surfaces to receive a visual assessment for deteriorated paint include walls, floors, ceilings, buiit in cabinets (sink bases), baseboards, doors, door frames, windows systems including mullions, sills, or frames and any other painted building compo- nent within the unit. Deteriorated paint includes any painted surface that is peeling, chipping, chaiking, cracking, damaged or otherwise separated from the substrate. All deteriorated paint surfaces more than 2 sq. ft, In anyone interior room or space, or more than 10% of the total surface area of an interior type of component with a small surface area (i.e., window sills, baseboards, and trim) must be stabi- lized (corrected) in accordance with all safe work practice requirements and clearance is required. If the deteriorated painted surface is less than 2 sq. ft. or less than 10% of the component, only stabilization is required. Clearance testing is not required. Stabilization means removal of deteriorated paint, repair of the substrate, and application of a new protective coating or paint. Lead-Based Paint Owner Certification is required follOWing stabilization activities, except for de minimis lAVAl rAD;:tir~ form HUD-52580-A (9//2000) ref Handbook 7420.8 1. Living Room For each numbered item, check one box only. - Decision Item Description > If Failor w 'w If Fail, what repairs are necessary? Inconclusive, No, w rn ~ "- '" U If Inconclusive. give details. dale (mm/ddlyyyy) u. c .,; 0 0 If Pass with comments, give details. of final approval ~ u Z c 1.1 living Room Present DD Is there a living room? 1.2 Electricity Are there at least two working outlets or one working DDD outlet and one working light fixture? 1.3 Electrical Hazards Is the room free from electrical hazards? DDD 1.4 Security Are all windows and doors that are accessible from the outside lockable? DD 1,5 Window Condition Is there at least one window, and are all windows free of signs of severe deterioration or missing or DD broken out panes? 1.6 Ceiling Condition Is the ceiling sound and free from hazardous defects? DD 1.7 Wall Condition Are the walls sound and free from hazardous defects? DD 1.8 Floor Condition Is the floor sound and free from hazardous defects? DD 1.9 Lead-Based Paint Are all painted surfaces free of deteriorated paint? DD If no, does deteriorated surfaces exceed two square DD D Not Applicable feet and/or more than 10% of a component? Additional Comments: (Give Item Number) Comments continued on a separate page Yes 0 No D Previous editions are obsolete Page 3 of 20 form HUD.52580-A (9/12000) ref Handbook 7420.8 2. Kitchen 2.1 Kitchen Area Present Note: A kitchen is an area used for preparation of meals. It may be either a separate room or an area of a larger room (for example, a kitchen area in an efficiency apartment). 2.2 . 2.9 Explanation for these items is the same as that pro- vided for "Living Room" with the fOllowing modifica- tions: 2.2 Electricity Note: The requirement is that at least one outlet and one permanent light fixture are present and working. 2.5 Window Condition Note: The absence of a window does not fail this item in the kitchen. If there is no window, check "Pass.- 2.10 Stove or Range with Oven Both an oven and a stove (arrange) with top burners must be present and working. If either Is missing and you know that the owner is responsible for supplying these appliances, check "Fail." Put check in "Inconclusive" column If the tenant is responsible for supplying the appliances and he or she has not yet moved in. Contact tenant or prospective tenant to gain verification that facility will be supplied and is in working condition. Hot plates are not acceptable substitutes for these facilities. An oven is not working if it will not heat up. To be working a stove or range must have all burners working and knobs to turn them off and on. Under "working condition," also look for hazardous gas hook-ups evidenced by strong gas smells; these should fail. (Be sure that this condition is not confused with an unlit pilot light -a condition that should be noted, but does not fail.) If both an oven and a stove or range are present, but the gas or electricity are turned off, check "lnconcluslve." Contact owner or manager to get verification thatfacility works when gas Is turned on. If both an oven and a stove or range are present and working, but defects exist, check "Pass" and note these to the right of the form. Possible defects are marked, dented, or scratched surfaces; cracked burner ring; limited size relative to family needs, A microwave oven may be substituted for a tenant~supplied oven and stove (or range). A microwave oven may be substituted for an owner~supplied oven and stove (or range) if the tenant agrees and microwave ovens are furnished instead of ovens and stoves (or ranges) to both subsidized and unsubsidized tenants in the building or premises. 2.11 Refrigerator If no refrigerator is present, use the same criteria for marking either "Fail" or "Inconclusive" as were used for the oven and stove or range. A refrigerator is not working if it will not maintain a temperature low enough to keep food from spoiling over a reasonable period of time, lithe eiectricity is turned off, mark "Inconclusive." Contact owner (or tenant if unit is occupied) to get verification of working condition. If the refrigerator Is present and working but defects exist, note lhese to the right of the form. Possible minor defects include: broken or missing interior shelving; dented or scratched interior or exterior surfaces; minor deterioration of door seal; loose door handle. 2.12 Sink if a permanentiy attached kitchen sink is not present in the kitchen or kitchen area, mark "Fail," A sink in a bathroom or a portable basin will not satisfy this requirement. A sink is not working unless it has running hot and cold water from the faucets and a properly con- nected and properiy working drain (with a "gas trap"). in a vacant aparlment. the hot water may have been turned off and there will be no hot water. Mark this "Inconclusive." Check. with owner or manager to verify that hot water is available when service is turned on. If a working sink has defects, note this to the right of the item. Possible minor defects include: dripping faucet; marked, dented, or scratched surface; slow drain; missing or broken drain stopper. 2.13 Space for Storage, Preparation, and Serving of Food Some space must be available for the storage, preparation, and serving of food. if there is no built-in space for food storage and preparation, a table used for food preparation and a portable storage cabinet will satisfy the requirement. If there is no buiit-in space, and no room for a table and portable cabinet, check "Inconclusive" and discuss with the tenant. The tenant makes the final determination as to whether or not this space is acceptable. If there are some minor defects, check "Pass" and make notes to the right. Possible defects include: marked. dented, or scratched sur- faces; broken shelving or cabinet doors; broken drawers or cabinet hardware; limited size relative to family needs. Previous editions are obsolete Page 4 of 20 form HUD-52580-A (9//2000) ref Handbook 7420.8 2. Kitchen ~_._. Decision Item Description 00 > If Fail or .w No. 00 ~ If Fail, what repairs are necessary? Inconclusive, '" "- ... U If Inconclusive, give details. date (mmlddlyyyy) "- < '" <5 0 If Pass with comments, give details. of final approval w 0 >- z < 2.1 Kitchen Area Present DD Is there a kitchen? 2.2 Electricity Are there at least one working outlet and one work- ing, permanently installed light fixture? DDD 2,3 Electrical Hazards Is the kitchen free from electrical hazards? ODD 2.4 Security Are all windows and doors that are accessible from the outside lockable? DD 2.5 Window Condition Are all windows free of signs of deterioration or missing or broken out panes? DD 2,6 Ceiling Condition Is the ceiling sound and free from hazardous defects? DD 2.7 Wall Condition Are the walls sound and free from hazardous defects? DD 2.8 Floor Condition Is the floor sound and free from hazardous defects? OD 2.9 Lead-Based Paint Are all painted surfaces free of deteriorated paint? DD If no, does deteriorated surfaces exceed two square DO D feet and/or less than 10% of a component? Not Applicable 2.10 Stove or Range with Oven Is there a working oven, and a stove (or range) with ODD top burners that work? If no oven and stove (or range) are present, is there a microwave oven and, if microwave is owner-sup- plied, do other tenants have microwaves instead 0 DDD an oven and stove (or range)? 2.11 Refrigerator Is there a refrigerator that works and maintains a temperature low enough so that food does not spoil DDD over a reasonable period of time? -- 2,12 Sink Is there a kitchen sink that works with hot and cold DDD running water? 2.13 Space for Storage, Preparation, and Serving of Food Is there space to store, prepare, and serve food? DDD For each numbered item, check one box only. Additional Comments: (Give Item NumberHUse an additional page if necessary) Comments continued on a separate page Yes D No D Previous editions are obsolete Page 5 of 20 form HUO-52580-A (9112000) ref Handbook 7420.8 3. Bathroom 3.1 Bathroom Present Most units have easily identifiable bathrooms (i.e., a separate room with tollet, washbasin and tub or shower). In some cases, however, you will encounter units with scattered bathroom facilities (Le., toilet. washbasin and tub or shower located in separate parts of the unit). At a minimum, there must be an enclosure around the toilet. In this case, count the enclosure around the toilet as the bathroom and proceed with 3.2-3.9 below, with respect to this enclosure. If there is more than one bathroom that is normally used. rate the one that is in best condition for Part 3. Ifthere is a second bathroom that is also used, complete Part 4 of the checklist for this room. (See Inspection Manual for additional notes on rating the second bathroom.) 3.2 - 3.9 Explanation for these items is the same as that pro- vided for "Uving Room" with the following modifica- tions: 3.2 Electricity Note: The requirement is that at least one permanent light fixture is present and working 3.3 Electrical Hazards Note: In addition to the previously mentioned hazards, outlets that are located where water might spiash or collect are considered an electrical hazard. 3.5 Window Condition Note: The absence of a window does not fail this item in the bathroom (see item 3.13. Ventilation, for relevance of window with respect to ventilation). If there is no window, but a workin9 vent system is present, check "Pass." 3.7 Wall Condition Note: Include under nonhazardous defects (that would pass, but should be noted) the following: broken or loose tile; deteriorated grouting at tub/wall and tub/floor joints, or tiled surfaces; water stains. 3.8 Floor Condition Note: include under nonhazardous defects (that would pass. but should be noted) the following: missing floor tiles; water stains. 3.10 Flush Toitet in Enclosed Room in Unit The toilet must be contained within the unit, be in proper operating condition, and be available for the exclusive use of the occupants of the unit (i.e., outhouses or facilities shared by occupants of other units are not acceptable). It must allow for privacy. Not working means: the toilet is not connected to a water supply; it is not connected to a sewer drain; it is clogged; it does not have a trap; the connections, vents or traps are faulty to the extent that severe leakage of water or escape of gases occurs; the flushing mechanism does not function properly. If the water to the unit has been turned off, check "Inconclusive." Obtain verification from owner or manager that facility works properly when water is tumed on. Comment to the right of the form if the toilet is "present, exciusive, and working," but has the following types of defects: constant running; chipped or broken porcelain; slow draining. If drain blockage is more serious and occurs further in the sewer line, causing backup, check item 7.6, "Fail," under the piumbing and heating part of the checklist. A sign of serious sewer blockage ;s the presence of numerous backed-up drains, 3.11 Fixed Wash Basin or Lavatory in Unit The wash basin must be permanently installed (I.e., a portable wash basin does not satisfy the requirement). Also, a kitchen sink used to pass the requirements under Part 2 olthe checklist (kitchen facilities) cannot also serve as the bathroom wash basin. The wash basin may be located separate from the other bathroom facilities (e.g., in a hallway). Not working means: the wash basin is not connected to a system that will deliver hot and cold running water; it is not connected to a properly operating drain; the connectors (or vents or traps) are faulty to the extent that severe leakage of water or escape of sewer gases occurs. If the water to the unit or the hot water unit has been turned off, check "Inconclusive." Obtain verification from owner or manager that the system is in working condition. Comment to the right of the form if the wash basin is "present and working," but has the foHowing types of minor defects: insufficient water pressure; dripping faucets; minor leaks; cracked or chipped porcelain; slow drain (see discussion above under 3.10). 3.12 Tub or Shower in Unit Not present means that neither a tub nor shower is present in the unit. Again, these facilities need not be ;n the same room with the rest of the bathroom facilities. They must, however, be private. Not working covers the same requirements detailed above for wash basin (3.11). Comment to the right of the form If the tub or shower is present and working, but has the following types of defects: dripping faucet; minor leaks: cracked porceiain; slow drain (see discussion under 3.10); absent or broken support rod for shower curtain. 3.13 Venlllation Working vent systems include: ventliatlon shafts (non-mechanical vents) and eiectric fans. Electric vent fans must function when switch is turned on. (Make sure that any malfunctions are not due to the fan not being plugged in.) If electric current to the unit has not been turned on (and there is no open able window), check "Inconclusive." Obtain verification from owner or manager that system works. Note: exhaust vents must be vented to the' outside, attic, or crawlspace. Previous editions are obsolete Page 6 of 20 form HUD.52580-A (9//2000) ref Handbook 1420.8 3. Bathroom For each numbered item, check one box only. ._- Decision Item Description ~ If Failor 00 ." No. 00 ~ If Fail, what repairs are necessary? Inconclusive, '" "- .~ <J If Inconclusive, give details. date (mm/ddlyywJ u. 5 '" If Pass with comments, give details. of final approval ~ ci 0 Z 0 3.1 Bathroom Present (See description) DO Is there a bathroom? 3.2 Electricity Is there at least one permanently installed light fixture?, 0 00 3.3 Electrical Hazards Is the bathroom free from electrical hazards? 000 3.4 Security Are a/I windows and doors that are accessible from DO the outside lockable? 3.5 Window Condition Are all windows free of signs of deterioration or DO missing or broken out panes? 3.6 CeiHng Condition Is the ceiling sound and free from hazardous defects? 00 3.7 Wall Condition Are the walls sound and free from hazardous defects? DO 3.8 Floor Condition Is the floor sound and free from hazardous defects? DO 3.9 Lead-Based Paint 00 Are all painted surfaces free of deteriorated paint? If no, does deteriorated surfaces exceed two square 00 o Not Applicable feet and/or more than 10% of a component? 3.10 Flush Toilet in Enclosed Room in Unit Is there a working toilet in the unit for the exclusive private use of the tenant? ODD 3.11 Fixed Wash Basin or lavatory in Unit Is there a working, permanently installed wash basin with hot and cold running water in the unit? ODD 3.12 Tub or Shower Is there a working tub or shower with hot and cold 000 running water in the unit? 3.13 Ventilation Are there openable windows or a working vent sys- 000 tem? ~~ Additional Comments: (Give Item Number)(Use an additional page if necessary) Comments continued on a separate page Yes 0 No D Previous editions are obsolete Page 7 of 20 form HUD-52580-A (9//2000) ref Handbook 7420.8 4. Other Room Used for Living and Halls Complete an HOther Room" checklist for as many Wother rooms used for living" as are present in the unit and not already noted in Parts I, 2, and 3 of the checklist. See the discussion below for definition of "used for living." Also complete an "Other Roomn checklist for all entrance halls, corridors. and staircases that are located within the unit and are part of the area used for living. If a hall, entry and/or stairway are contiguous, rate them as a whole (Le" as part of one space), Additional forms for rating WOther Rooms" are provided in the check- list. Definition ot"used for living." Rooms "used for living" are areas oftha unit that are walked through or lived in on a regular basis. Do not include rooms or other areas that have been permanently, or near permanently, closed off or areas that are infrequently entered. For example, do not include a utility room, attached shed, attached closed-in porch, basement, or garage if they are ciosed off from the main living area or are infrequently entered. 00 include any of these areas if they are frequently used (e.g., a finished basemenUplay- room, a closed-in porch that is used as a bedroom during summer months). Occasional use afa washer or dryer in an othelWise unused room does not constitute regular use. If the unit is vacant and you do not know the eventual use of a particular room, complete an "Other Room" checklist if there is any chance that the room will be used on a regular basis. If there is no chance that the room will be used on a regular basis, do not include it (e.g., an unfinished basement) since it will be checked under Part 5, All Secondary Rooms (Rooms not used for living), 4.1 Room Code and Room Location Enter the appropriate room code given below: Room Codes: 1 = Bedroom or any otherroom used forsieeping (regardless oftype of room) 2 = Dining Room or Dining Area 3 = Second Living Room, Family Room, Den, Piayroom, TV Room 4 = Entrance Halls, Corridors, Halls, Staircases 5 = Additional Bathroom (also check presence of sink trap and clogged toilet) 6 = Other Room Location: Write on the line provided the location ofthe room with respect to the unit's width, length and floor ievel as if you were standing outside the unit facing the entrance to the unit: righUlefUcenter: record whether the room is situated to the right, left, or center of the unit. fronUrear/center: record whether the room is situated to the back, front or center of the unit. floor level: identify the floor level on which the room is located. If the unit is vacant, you may have some difficulty predicting the eventual use of a room. Before giving any room a code of 1 (bedroom), the room must meet all of the requirements for a "room used for sleeping" (see items 4. 2 and 4.5). 4.2.. 4.9 Explanations of these items are the same as those provided for j'Livlng Room" with the following modi- fications: 4.2 Electrlcity/lllumination If the room code is not a "1," the room must have a means of natural or artificial illumination such as a permanent light fixture, wall outlet present, or light from a window in the room or near the room. If any required item is missing, check "FaiL" If the electricity is turned off, check "Inconclusive." 4.5 Window Condition Any room used for sleeping must have at least one window, If the windows in sleeping rooms are designed to be opened, at least one window must be openable. The minimum standards do not require a window in "other rooms." Therefore, if there is no window in another room not used for sleeping, check "Pass," and note "no window" in the area for comments. 4.6 Smoke Detectors At least one battery-operated or hard-wired smoke detector must be present and working on each level of the unit, includ- ing the basement, but not the crawl spaces and unfinished attic. Smoke detectors must be installed in accordance with and meet the requirements of the National Fire Protection Associa. tion Standard (NFPA) 74 (or its successor standards). If the dwelling unit is occupied by any hearing-impaired per- son, smoke detectors must have an alarm system designed for hearing-impaired persons as specified in NFPA 74 (orsucces- sor standards). If the unit was under HAP contract prior to April 24, 1993, owners who installed battery-operated or hard-wired smoke detectors in compliance with HUD's smoke detector require- ments, including the regulations published on July 30, 1992 (57 FR 33846), will not be required subsequently to comply with any additional requirements mandated by NFPA 74 (Le, the owner would not be required to install a smoke detector in a basement not used for living purposes, nor would the owner be required to change the location of the smoke detectors that have already been installed on the other floors of the unit). In this case, check .Pass" and note under comments. Additional Notes For staircases, the adequacy of light and condition of the stair rails and railings is covered under Part 8 of the checklist (General Health and Safety) Page 8 of 20 form H U D-52580.A (9//2000) ref Handbook 7420.8 Previous editions are obsolete 4. Other Rooms Used for Living and Halls For each numbered item, check one box only. 4.1 Room Location righVlefUcenter: the room is situated to the right, lell, or center of the unit. fronUrear/center: the room is situated to the back, front or center of the unit. floor level: the floor level on which the room is located. Room Code D 1 = Bedroom or Any Other Room Used for Sleeping (regardless of type of room) 2 = Dining Room or Dining Area 3 = Second Living Room, Family Room, Den, Playroom, TV Room 4 = Entrance Halls, Corridors, Halls, Staircases 5 = Additional Bathroom (also check presence of sink trap and clogged toilet) 6 = Other: Decision Item Description > If Fail or w .;;; If Fail. what repairs are necessary? Inconclusive. No. w m ~ a. '" U If Inconclusive, give details. dale (mm/dd/yyyy) "- c u; 0 0 If Pass with comments, give details. of final approval ~ u >- Z c 4.2 Electricity/III um inatlon If Room Code is a 1. are there at least two working outlets or one working outlet and one working, perma- ODD nently installed light fixture? If Room Code is nota 1 ,is there a means of illumination? DDD 4.3 Electrical Hazards Is the room free from electrical hazards? DDD 4.4 Security Are all windows and doors that are accessible from the outside lockable? DD 4.5 Window Condition If Room Code is a 1, is there at least one window? DD And, regardless of Room Code, are all windows free of signs of severe deterioration or missing or broken- DD out panes? 4.6 Ceiling Condition Is the ceiling sound and free from hazardous defects? DD 4.7 Wall Condition Are the walls sound and free from hazardous defects? DD 4.8 Floor Condition Is the floor sound and free from hazardous defects? DD n. 4.9 Lead-Based Paint DD Are all painted surfaces free of deteriorated paint? If no, does deteriorated surfaces exceed two square DD D Not Applicable feet and/or more than 10% of a component? 4.10 Smoke Detectors Is there a working smoke detector on each level? DD Do the smoke detectors meet the requirements of DD NFPA 747 In units occupied by the hearing impaired, is there an DD alarm system connected to the smoke detector? Additional Comments: (Give Item Number)(Use an additional page if necessary) Comments continued on a separate page Yes 0 No D Previous editions are obsolete Page 9 of 20 form HUD-52580-A (9//2000) ref Handbook 7420.8 4. Supplemental for Other Rooms Used for Living and Halls For each numbered item. check one box only. 4.1 Room Location Room Code 0 right/left/center: the room is situated to the right. left, 1 : Bedroom or Any Other Room Used for Sleeping (regardless of or center of the unil. type of room) fronVrear/center: the room is situated to the back, front 2 = Dining Room or Dining Area or center of the unit. 3: Second Living Room, Family Room, Den, Playroom. TV Room floor level: the floor level on which the room is 4 = Entrance Halls. Corridors, Halls, Staircases located. 5 Additional Bathroom (also check presence of sink trap and clogged toilet) 6: Other: Decision Item Description ~ If Fail, what repairs are necessary? If Failor ~ ';;; No, 0 If Inconclusive, give details. Inconclusive, ~ ~ "'- ',. " If Pass with comments, give details. date of final u. c .; 0 ~ 0- 0 approval z c 4.2 Electricity/Illumination If Room Code is a 1, are there at least two working outlets or one working outlet and one working, perma- 000 nently installed light fixture? If Room Code is nota 1, is there a means ofilluminatiC?n? ODD 4.3 Electrical Hazards 000 Is the room free from electrical hazards? 4.4 Security Are all windows and doors that are accessible from DO the outside lockable? 4.5 Window Condition 00 If Room Code is a 1, is there at least one window? And, regardless of Room Code, are all windows free of signs of severe deterioration or missing or broken~ DO out panes? 4.6 Ceiling Condition 00 Is the ceiling sound and free from hazardous defects? 4.7 Wall Condition DO Are the walls sound and free from hazardous defects? 4.8 Floor Condition DO Is the floor sound and free from hazardous defects? 4.9 Lead-Based Paint DO Are all painted surfaces free of deteriorated paint? If no, does deteriorated surfaces exceed two square 00 ~ Not Applicable feet and/or more than 10% of a component? 4.10 Smoke Detectors 00 /5 there a working smoke detector on each level? 00 the smoke detectors meet the requirements of DO NFPA 74? In units occupied by the hearing impaired, is there an 0 0 alarm system connected to the smoke detector? Additional Comments: (Give item Number)(Use an additional page if necessary) Comments continued on a separate page Yes 0 No 0 Previous editions are obsolete Page 10 of 20 form HUD.525SD-A (9//2000) ref Handbook 7420.8 4. Supplemental for Other Rooms Used for Living and Halls For each numbered item, check one box Only,___ 4.1 Room Location Room Code D righUleftlcenter: the room is situated to the right, left, 1 = Bedroom or Any Other Room Used for Sleeping (regardless of or center of the unit. type of room) fronUrear/center: the room is situated to the back, front 2 Dining Room or Dining Area or center of the unit. 3 :: Second Living Room, Family Room, Den, Playroom. TV Room floor level: the floor level on which the room is 4 = Entrance Halls, Corridors, Halls, Staircases located. 5 Additional Bathroom (also check presence of sink trap and clogged toilet) 6 Other: Decision Item Description ~ I(Failor '" '~ No, '" ~ If ~ail, what repairs are necessary? Inconclusive, ., a. '<ij '0 If Inconclusive, give details. date (mm/ddlyyyy) LL c ~ 6 0 If Pass with comments, give details. of final approval u z c 4.2 Electricity/lllumi nation If Room Code is a 1, are there at least two working outlets or one working outlet and one working, perma. ODD nently installed light fixture? If Room Code is nota 1, is there a means of illumination? ODD 4.3 Electrical Hazards Is fhe room free from electrical hazards? ODD 4.4 Security Are all windows and doors that are accessible from the outside lockable? DO 4.5 Window Condition If Room Code is a 1. is there at least one window? 00 And. regardless of Room Code, are all windows free of signs of severe deterioration or missing or broken- DO out panes? 4.6 Ceiling Condition Is the ceiling sound and tree from hazardous defects? 00 4.7 Wall Condition Are the walls sound and free from hazardous defects? 00 4.8 Floor Condition 00 Is the floor sound and free from hazardous defects? 4.9 Lead-Based Paint 00 Are all painted surfaces free of deteriorated paint? If no, does deteriorated surfaces exceed two square 00 o Not Applicable feet and/or more than 10% of a component? 4.10 Smoke Detectors Is there a working smoke detector on each level? DO Do the smoke detectors meet the requirements of DO NFPA 747 In units occupied by the hearing impaired, is there an DO alarm system connected to the smoke detector? Additional Comments: (Give lIem Number)(Use an additional page if necessary) Comments continued on a separate page Yes 0 No 0 Previous editions are obsolete Page 11 of20 form HUD-52580-A (9//2000) ref Handbook 7420.8 4. Supplemental for Other Rooms Used for Living and Halls For each numbered item, check one box only. -------- 4.1 Room location Room Code D righUleftJcenter: the room is situated to the right. left, 1 = Bedroom or Any Other Room Used for Sleeping (regardless of or center of the unit. type of room) fronVrear/center: the room is situated to the back, front 2 = Dining Room or Dining Area or center of the unit 3 = Second Living Room, Family Room, Den, Playroom, TV Room floor level: the floor level on which the room is 4 ;;: Entrance Halls, Corridors, Halls, Staircases located. 5 = Additionat Bathroom (also check presence of sink trap and clogged toilet) 6 = Other: Decision Item Description ;: If Failor ~ .~ If Fait, what repairs are necessary? Inconclusive. No. ~ ~ .. "- 'OJ " If Inconclusive, give details. date (mm/dd/yyyy) u. c ,; 0 0 If Pass with comments, give details. of final approval ~ u Z c 4.2 Electrlcitynllumination If Room Code is a 1, are there at least two working outlets or one working outlet and one working, perma- ODD nently installed light fixture? If Room Code is nota 1, is there a means ofillumination? ODD 4.3 Electrical Hazards Is the room free from electrical hazards? ODD 4.4 Security Are all windows and doors that are accessible from the outside lockable? DO 4.5 Window Condition If Room Code is a 1, is there at least one window? DO And, regardless of Room Code, are all windows free of signs of severe deterioration or missing or broken- DO out panes? 4.6 Ceiling Condition Is the ceiling sound and free from hazardous defects? DD 4.7 Wall Condition Are the walls sound and free from hazardous defects? DO 4.8 Floor Condition DO Is the floor sound and free from hazardous defects? -- 4.9 Lead-Based Paint DO Are all painted surfaces free of deteriorated paint? If no, does deteriorated surfaces exceed two square DO o Not Applicable feet and/or more than 10% of a component? 4.10 Smoke Detectors Is there a working smoke detector on each level? DO 00 the smoke detectors meet the requirements of DO NFPA 74? In units occupied by the hearing impaired, is there an DO alarm system connected to the smoke detector? Additional Comments: (Give Item Number)(Use an additional page if necessary) Comments continued on a separate page Yes 0 No 0 Previous editions are obsolete Page 12 of 20 form HUD-52580-A (9//2000) ref Handbook 7420.8 5. All Secondary Rooms (Rooms not used for living) 5. Secondary Rooms (Rooms not used for living) If any room in the unit did not meet the requirements for Mother room used for living" in Part 4, it is to be considered a "secondary room (not used for living)," Rate all of these rooms together (Le., a single Part 5 checklist for all secondary rooms in the unit). Inspection is required of the following two items since hazardous defects under these items could jeopardize the rest of the unit, even if present in rooms not used for living: 5.2 Security, 5.3 Electrical Hazards. Also. be observant of any other potentially hazardous features in these rooms and record under 5.4 5.1 None If there are no "Secondary Rooms (rooms not used for living)," check "None" and go on to Part 6. 5.2 . 5.4 Explanations of these items is the same as those provided for "living Room" Additional Note In recording "other potentially hazardous features," note (in the space provided) the means of access to the room with the hazard and check the box under "Inconclusive." Discuss the hazard with the HA inspection supervisor to determine "Pass" or "Fail." Include defects like: large holes in floor, walls or ceilings; evidence of structural collapse; windows in condition of severe deterioration; and deterio- rated paint suriaces. 6. Building Exterior 6.1 Condition of Foundation "Unsound or hazardous" means foundations with severe structural defects indicating the potential for structural collapse; or foundations that allow significant entry of ground water (for example, evidenced by flooding of basement). 6.2 Condition of Stairs, Rails, and Porches "Unsound or hazardous" means: stairs, porches, balconies, or decks with severe structural defects; broken, rotting, or missing steps; absence of a handrail when there are extended lengths of steps (generally four or more consecutive steps); absence of or insecure railings around a porch or balcony which is approximately 30 inches or more above the ground. 6.3 Condition of Roof and Gutters "Unsound and hazardous" means: The roof has serious defects such as serious buckling or sagging, indicating the potential of structural collapse; large holes Or other defects that would result in significant air or water infiltration (in most cases severe exterior defects will be reflected in equally serious suriace defects within the unit, e.g., buckling, water damage). The gutters, downspouts and soffits (area under the eaves) show serious decay and have allowed the entry of significant air or water into the interior of the structure. Gutters and downspouts are, however, not required to pass. If the roof is not observable and there is no sign of interior water damage, check "Pass." 6.4 Condition of Exterior Surfaces See definition above for roof, item 6.3. 6.5 Condition of Chimney The chimney should not be seriously leaning or showing evidence of significant disintegration (i.e., many missing bricks). 6.6 Lead-Based Paint: Exterior Surfaces Housina Choice Voucher Units If the unit was built January 1, 1978 or after, no child under age six will occupy or currently occupies, is a O-SR, elderly or handicapped unit with no children under age six on the lease or expected, has been certified lead- based paint free by a certified lead-based paint inspector (no lead-based paint present or no lead-based paint present after removal of lead). check NA and do not inspect painted surfaces. Visual assessment for deteriorated paint applies to all exterior painted surfaces (building components) associated with the assisted unit including windows, window sills, exterior walls, floors, porches, railings, doors, decks, stairs, play areas, garages, fences or other areas if frequented by children under age six. All deteriorated paint suriaces more than 20 sq. ft. on exterior surfaces must be stabilized (corrected) in accordance with all safe work practice requirements. If the painted surface is less than 20 sq. ft., only stabilization is required. Clearance testing is not required. Stabilization means removal of deterio- rated paint, repair of the substrate, and application of a new protective coating or paint. Lead-Based Paint Owner Certifica- tion is required following stabilization activities except for de minimis level repairs. 6.7 Manufactured Homes: Tie Downs Manufactured homes must be placed on a site in a stable manner and be free from hazards such as sliding and wind damage. Manu- factured homes must be securely anchored by a tiedown device which distributes and transfers the loads imposed by the unit to appropriate ground anchors so as to resist wind overturning and sliding. unless a variation has been approved by the HUD Field Office. Page 13 of 20 form HUD.52580-A (9//2000) ref Handbook 7420.8 Previous editions are obsolete 5. All Secondary Rooms (R""ms n"t used ,,,' living) For each numbered item, check one box only. . - Decision Item Description .~ If Fail or ~ No. ~ ~ If Fail, what repairs are necessary? IncDnclusive. rn ~ 0- '" 0 If Inconclusive, give detalls. date (mm/dd/yyyy) u. < .,; 05 " If Pass with comments, give details. of final approval .e u z < 5.1 None 0 Go to Part 6 , 5.2 Security Are all windows and doors that are accessible from the outside lockable? DO 5.3 Electrical Hazards Are all these rooms free from electrical hazards? ODD 5.4 Other Potentially Hazardous Features Are all of these rooms free of any other potentially hazardous features? For each room with an "other potentially hazardous feature," explain the hazard ODD and the means of control of interior access to the room. 6.0 Building Exterior 6,1 Condition of Foundation Is the foundation sound and free from hazards? DO 6.2 Condition of Stairs, Ralls, and Porches Are all the exterior stairs, rails. and porches sound DO and free from hazards? 6.3 Condition of Roof and Gutters Are the roof, gutters, and downspouts sound and DO free from hazards? -~ 6.4 Condition of Exte,ior Surfaces Are exterior surfaces sound and free from hazards? DO 6.5 Condition of Chimney Is the chimney sound and free from hazards? DO 6.6 Lead-Based Paint: Exterior Surfaces 0 0 Are all painted surfaces Iree of deteriorated paint? If no. does deteriorated surfacas exceed 20 sq. ft, of 00 o Not Applicable total exterior surface area? 6.7 Manufactured Homes: Tie Downs If the unit is a manufactured home. is it properly placed DO and tied down? If not a manufactured home. check DO o Not Applicable "Not Applicable." Additional Comments: (Give Item Number)(Use an additional page if necessary) Comments continued on a separate page Yes D No 0 Previous editions are obsolete Page 14 of 20 form HUD.52580.A (9//2000) ref Handbook 7420.8 7. Heating and Plumbing 7.1 Adequacy of Heating Equipment "Adequate heat" means that the heating system is capable of delivering enough heat to assure a healthy environment in the unit (appropriate to the climate). The HA is responsible for defining what constitutes a healthy living environment in the area of the country in which it operates. Local codes (city or state codes) should be instructive in arriving at a reasonable local definition. For example, for heat adequacy, local codes often require that the unit's heating facility be capable of maintaining a given tempera- ture level during a designated time period. Portable electric room heaters or kitchen stoves or ranges with a built-in heat unit are not acceptable as a primary source of heat for units located in areas where climate conditions require regular heating. ~Oirectly or indirectly to all rooms used for living" means: "directly" means that each room used for living has a heat source (e.g., working radiator; working hot air register; baseboard heat) "indirectly" means that, if there is no heat source present in the room, heat can enter the room easily from a heated adjacent room (e.g a dining room may not have a radiator, but would receive heat from the heated living room through a large open archway). If the heating system in the unit works, but there is some question whether a room without a heat source would receive adequate indirect heat, check "'nconclusive" and verify adequacy from tenant or owner (e.g., unheated bedroom at the end of a long hallway). How to determine the capability of the heating system: If the unit is occupied, usually the quickest way to determine the capability of the heating system over time is to question the tenant. If the unit is not occupied. or the tenant has not lived in the unit during the months when heat would be needed. check "Inclusive." It will be necessary to question the owner on this point after the inspection has been completed and, if possible, to question other tenants (if it is a multi-unit structure) about the adequacy of heat provided. Under some circumstances, the adequacy of heat can be deter- mined by a simple comparison of the size of the heating system to the area to be heated. For example, a small permanently installed space heater in a living room is probably inadequate for heating anything larger than a relatively small apartment. 7.2 Safety of Heating Equipment Examples of ~unvented fuel burning space heaters" are: portable kerosene units; unvented open flame portable units. "Other unsafe conditions" include: breakage or damage to heat- ing system such that there is a potential for fire or other threats to safety; improper connection of flues allowing exhaust gases to enter the living area; improper installation of equipment (e.g., proximity of fuel tank to heat source, absence of safety devices); indications of improper use of equipment (e.g., evidence of heavy build-up of soot, creosote, or other substance in the chimney); disintegrating equipment; combustible materials near heat source or flue. Seelnspection Manual for a more detailed discussion of the inspection of safety aspects of the heating systems. If you are unable to gain access to the primary heating system in the unit check "Inconclusive." Contact the owner or manager for verification of safety of the system. If the system has passed a recent local inspection, check "Pass." This applies especially to units in which heat is provided by a large scale, complex central heating system that serves multiple units (e.g., a boiler in the basement of a large apartment building). In most cases, a large scale healing system for a multi.unit building will be subject to periodic safety inspections by a local public agency. Check with the owner or manager to determine the date and outcome of the last such inspection, or look for an inspection certificate posted on the heating system. 7.3 Ventilation and Adequacy of Cooling If the tenant is present and has occupied the unit during the summer months, inquire about the adequacy of air flow. If the tenant is not present or has not occupied the unit during the summer months, test a sample of windows to see that they open (see Inspection Manual for instruction). "Working cooling equipment" includes: central (fan) ventilation system: evaporative cooling system; room or central air conditioning. Check "Inconclusive" if there are no open able windows and it is impossible, or inappropriate, to test whether a cooling system works. Check with other tenants in the building (in a multi-unit structure) and with the owner or manager for verification of the adequacy of ventilation and cooling. 7.4 Water Heater "location presents hazard" means that the gas or oil water heater is located in living areas Or closets where safety hazards may exist (e.g., water heater located in very cluttered closet with cloth and paper items stacked against it). Gas water heaters in bedrooms or other living areas must have safety dividers or shields. Water heaters must have a temperature-pressure relief valve and discharge line (directed toward the floor or outside of the living area) as a safeguard against build up of steam if the water heater malfunctions. If not, they are not properly equipped and shaB fail. To pass, gas or oil fired water heaters must be vented into a properly Installed chimney or flue leading outside. Electric water heaters do not require venting. If it is impossible to view the water heater, check "Inconclusive." Obtain verification of safety of system from owner or manager. Check "Pass" if the water heater has passed a local inspection. This applies primarily to hot water that is supplied by a large scale complex water heating system that serves multiple units (e.g., water heating system in large apartment building). Check in the same manner described for heating system safety, item 7.2, above. 7.5 Water Supply If the structure is connected to a city or town water system, check "Pass." If the structure has a private water supply (usually in rural areas) inquire Into the nature of the supply (probably from the owner) and whether it is approvable by an appropriate pubiic agency. General note: If items 7.5, 7.6, or 7,7 are checked "Inconclusive," check with owner or manager for verification of adequacy. 7.6 Plumbing "Major leaks" means that main water drain and feed pipes (often located In the basement) are seriously leaking. (Leaks present at specific facilities have already been evaluated under the checklist Items for "Bathroom" and "Kitchen."j "Corrosion" (causing serious and persistent levels of rust or contami- nation In the drinking water) can be determined by observing the color of the drinking water at several taps. Badly corroded pipes will produce noticeably brownish water. If the tenant is currently occupy- ing the unit, he orshe should be able to provide information about the persistence of this condition. (Make sure that the ~rusty water" is not a temporary condition caused by city or town maintenance of main water lines.) See general note under 7.5. 7.7 Sewer Connection If the structure is connected to the city or town sewer system, check ~Pass." If the structure has its own private disposal system (e.g., septic field), inquire into the nature of the system and determine whether this type of system can meet appropriate health and safety regulations. The following conditions constitute "evidence of sewer back up": strong sewer gas smell in the basement or outside of unit; numerous clogged or very slow drains; marshy areas outside of unit above septic field. See general note under 7.5. Page 15 of 20 form HUD-S2S80-A (9//2000) ref Handbook 7420.8 Previous editions are obsolete 7. Heating and Plumbing Fer each numbered item, check one box only. Decision Item Description 0 > If Failor No. 0 'in If Fail, what repairs are necessary? Inconclusive, " ~ 00- '" u If Inconclusive, give details. date (mmlddlyyyy) u. c .; <5 0 If Pass with comments, give details. of final approval ~ <.> Z c - - 7.1 Adequacy of Heating Equipment Is the heating equipment capable of providing ad- equate heat (either directly or indirectly) to all rooms ODD used for living? - 7.2 Safety of Heating Equipment Is the unit free from unvented fuel burning space heat- ers or any other types of unsafe heating conditions? ODD 7.3 Ventilation and Adequacy of Cooling Does the unit have adequate ventilation and cooling by ODD means of open able windows or a working cooling system? 7.4 Water Heater Is the water heater located, equipped, and installed DDD in a safe manner? 7.5 Water Supply Is the unit served by an approvable publiC or private DDD san~ary water supply? 7.6 Plumbing Is plumbing free from major leaks or corrosion that causes serious and persistent levels of rust or con. ODD tamination of the drinking water? 7.7 Sewer Connection Is plumbing connected to an approvable public or private disposal system. and is it free from sewer DDD back-up? Additional Comments: (Give Item Number) Comments continued an a separate page Yes 0 No 0 Previous editions are obsolete Page 16 of 20 form HUD.52580.A (9112000) ref Handbook 7420.8 8. General Health and Safety 8.1 Access to Unit "Through another unit" means that access to the unit Is only possible by means of passage through another dwelling unit. 8.2 Exits "Acceptable fire exit" means that the building must have an altema. live means of exit that meets local or State regulations in case of fire; this could include: An openable window if the unit is on the first floor or second floor or easily accessible to the ground. A back door opening on to a porch with a stairway leading to the ground. Fire escape, fire ladder, or fire stairs. "Blocked" means that the exit is not useable due to conditions such as debris, storage, door or window nailed shut, broken lock. Important note: The HA has the final responsibility for deciding whether the type of emergency exit Is acceptable, although the tenant should assist in making the decision. 8.3 Evidence of Infestation uPresence of rats, or severe infestation by mice or vermin" (such as roaches) is evidenced by: rat holes; droppings; rat runs; numerous settings of rat poison. If the unit is occupied, ask the tenant, 8.4 Garbage and Debris "Heavy accumulation" means large piles of trash and garbage, discarded furniture, and other debris (not temporarily stored awaiting removal) that might harbor rodents, This may occur inside the unit, in common areas, or outside. It usually means a level of accumula- tion beyond the capacity of an individual to pick up within an hour or two, 8.5 Refuse Disposal "Adequate covered facilities" includes: trash cans with covers, gar- bage chutes. "dumpsters" (I.e.. large scale refuse boxes with lids); trash bags (if approvable by local public agency). "Approvable by local public agency" means that the local Health and Sanitation Department (oily, town or county) approves the type offacility in use. Note: During the period when the HA is setting up its inspection program. it will check with the local health and sanitation department to determine which types of facilities are acceptable and inciude this in the inspection requirements. If the unit is vacant and there are no adequate covered facilities present, check ~Inconclusive." Contact the owner or manager for verification of facilities provided when the unit is occupied. 8.6 Interior Stairs and Common Halls "Loose, broken, or missing steps" should fail if they present a serious risk of tripping or faliing. A handrail is required on extended sections of stairs (generally four or more consecutive steps). A railing is required on unprotected heights such as around stairwells. "Other hazards" would be conditions such as bare electrical wires and tripping hazards. Housina Choice Voucher Units If the unit was built January 1, 1978, or after, no child under six will occupy or currently occupies it, is a O-SR, elderly or handicapped unit with no children under six on the lease or expected, has been certified lead-based paint free by a certified lead-based paint inspector (no lead-based paint present or no lead-based paint present after removal of lead- based paint.), check NA and do not inspect painted surfaces. This requirement applies to all painted surfaces (building compo- nents) within the unit. (Do not include tenant belongings). Surfaces to receive a visual assessment for deteriorated paint include walls, floors, ceilings, built in cabinets (sink bases), baseboards, doors, door frames, windows systems including mullions, sills, or frames and any other painted building compo- nent within the unit. Deteriorated paint includes any painted surface that is peeling, chipping, chalking, cracking, damaged or otherwise separated from the substrate. All deteriorated paint surfaces more than 2 sq. ft. in anyone interior room or space, or more than 10% of the total surface area of an interior type of component with a small surface area (i.e., window sills, baseboards, and trim) must be stabi- lized (corrected) in accordance with all safe work practice requirements and clearance is required. If the deteriorated painted surface is less than 2 sq. ft. or less than 10% of the component, only stabilization is required. Clearance testing is not required. Stabilization means removal of deteriorated paint, repair of the substrate, and application of a new protective coating or paint. Lead-Based Paint Owner Certification is required following stabilization activities, except for de minimis level repairs. 8.7 other Interior Hazards Examples of other hazards might be: a broken bathroom fixture with a sharp edge in a location where it represents a hazard; a protruding nail in a doorway. 8.8 Elevators Note: At the time the HA is setting up its inspection program, it will determine local licensing practices for elevators. Inspectors should then be aware of these practices in evaluating this item (e.g., check inspection date). If no elevator check "Not Applicable." 8.9 Interior Air Quality If the inspector has any questions about whether an existing poor air quality condition should be considered dangerous, he or she should check with the local Health and Safety Department (city, town or county) . 8.10 Site and Neighborhood Conditions Examples of conditions that would "seriously and continuously endanger the health or safety of the residents" are: other buildings on, or near the property, that pose serious hazards (e.g., dilapidated shed or garage with potential for structural collapse). evidence of flooding or major drainage problems, evidence of mud slides or large land settlement or collapse, proximity to open sewage, unprotected heights (cliffs, quarries, mines. sandpits), fire hazards, abnormal air pOllution or smoke which continues throughout the year and is determined to seriously endanger health, and continuous or excessive vibration of vehicular traffic (if the unit is occupied. ask the tenant). 8.11 Lead-Based Paint: Owner Certification If the owner is required to correct any lead-based paint hazards at the property including deteriorated paint or other hazards identi- fied by a visual assessor, a certified lead-based paint risk asses- sor, or certified lead-based paint inspector, the PHA must obtain certification that the work has been done in accordance with all applicable requirements of 24 CFR Part 35. The Lead-Based Paint Owner Certification must be received by the PHA before the execution of the HAP contract or within the time period stated by the PHA in the owner HaS violation notice. Receipt of the completed and signed Lead-Based Paint Owner Certification signifies that all HaS lead-based paint requirements have been met and no re-inspection by the HaS inspector is required. Previous editions are obsolete Page 17 of20 form HUD-5258a-A (9//2000) ref Handbook 7420.8 8. General Health and Safety Decision Item Description > If Fail or 0 .,. Inconclusive, No. 0 If Fail, what repairs are necessary? m ~ a. .~ U If Inconclusive, give details. date (mm/ddlyyyy) u. c Vi 0 a- If Pass with comments, give details. of final approval ~ 0 >- z c .-. - 8.1 Access to Unit Can the unit be entered without having to go through DD another unit? , - 8.2 Exits Is there an acceptable fire exit from this building that DD is not blocked? 8.3 Evidence of Infestation Is the unit free from rats or severe infestation by mice DD or vermin? 8.4 Garbage and Debris Is the unit free from heavy accumulation of garbage DD or debris inside and outside? 8.5 Refuse Disposal Are there adequate covered facilities for temporary storage and disposal of food wastes. and are they ODD approvable by a local agency? 8.6 Interior Stairs and Common Halls Are interior stairs and common halls free from haz- ards to the occupant because of loose, broken, or missing steps on stairways; absent or insecure rail- , ings; inadequate lighting; or other hazards? DDD 8.7 Other Interior Hazards Is the interior of the unit free from any other hazard DD not specifically identified previously? 8.8 Elevators Where local practice requires, do all elevators have a current inspection certificate? If local practice ODD does not require this, are they working and safe? D Not Applicable 8.9 Interior Air Quality Is the unit free from abnormally high levels of air pollution from vehicular exhaust, sewer gas, fuel DO gas, dust, or other pollutants? 8.10 Site and Neighborhood Conditions Are the site and immediate neighborhood free from conditions which would seriously and continuously DD endanger the health or safety of the residents? 8.11 Lead-Based Paint: Owner Certification If the owner of the unit is required to correct any deteriorated paint or lead-based paint hazards at the property, has the Lead-Based Paint Owner's Certification been completed, and received by the PHA? If the owner was not required to correct DD D any deteriorated paint or lead-based paint haz. Not Appl ica ble ards, check NA. -- For each numbered item. check one box only. Additional Comments: (Give Item Number) Comments continued on a separate page Yes D No D Previous editions are obsolete Page 18 of 20 form HUD-52580.A (9112000) ref Handbook 7420.8 Special Amenities (Optional) This Section is for optional use of the HA. It is designed to collect additional information about other positive features of the unit that may be present. Although the features listed below are not included In the Housing Quality Standards, the tenant and HA may wish to take them into consideration in decisions about renting the unit and the reasonableness of the rent. Check/list any positive features found in relation to the unit. 1. living Room o High quality noors or wall coverings o Working fireplace or stove o Balcony, patio, deck, porch o Special windows or doors o Exceptional size relative to needs of family o Other: (Specify) 4. Bath 2. Kitchen 0 Dishwasher 0 Separate (reezer 0 Garbage disposal 0 Eating counter/breakfast nook 0 Pantry or abundant shelving or cabinets 0 Double oven/setf cleaning oven, microwave 0 Double sink 0 High quality cabinets 0 Abundant counler.lop space 0 Modern appliance(s) 0 Exceptional size relative to needs of family 0 Other: (Specify) D Special feature shower head D Built.in heat lamp D Large mirrors o Glass door on showerltub o Separate dressing room D Double sink or special lavatory D Exceptional size relative to needs of family o Other: (Specify) 5, Overall Characteristics D Storm windows and doors o Other forms of weatherization (e.g., insulation, weather stripping) o Screen doors or windows o Good upkeep of grounds O.e., site cleanliness, landscaping, COl1ditionof~wn) o Garage or parking facilities o Driveway o Large yard o Good maintenance of building exterior o Other: (Specify) 3. Other Rooms Used for Living D High quality floors or wall coverings D Working fireplace or stove o Balcony, patio, deck, porch o Special windows or doors o Exceptional size relative to needs of family o Other: (Specify) 6, Disabled Accessibility Unit is accessible to a particular disability. Disability ______~_~___~________ DYes 0 No D. Questions to ask the Tenant (Optional) 1. Does the owner make repairs when asked? Yes 0 No 0 2. How many people live there? _____________ 3. How much money do you pay to the owner/agent for rent? $ ___________ 4. Do you pay for anything else? (specify) ____ ____ ______________________ 5. Who owns the range and refrigeralor?(insert 0:: Owner or T = Tenant} Range ____ 6. Is there anything else you want to tell us? (specify) ________ ~_____________ Refrigerator __ ____ Microwave Previous editions are obsolete Page 19 of 20 form HUD-52580-A (9//2000) ref Handbook 7420.8 Inspecllon Summary (Optional) Provide a summary description of each item which resulted in a rating of Fail or Pass with Comments. T ananllD No. Inspector Date of Inspection Address of ln$pected Un(\. o Special D Reinspection Reason for uFail" or "Pass with Comments" Rating Type of Inspection 0 Initial Uem Number Comments continued on a separate page Yes 0 No D Previous editions are obsolete Page 20 of 20 form HUD-52580-A (9//2000) ref Handbook 7420.6 RECORDING REQUESTED BY AND WHEN RECORDED RETURN TO: FREE RECORDING REQJESTED :Gov1t Code Section 6103) The City of Santa Ana 20 Civic Center Plaza P.O. Box 22030 Santa Ana, California 92702 AGREEMENT CONTAINING COVENANTS AFFECTING REAL PROPERTY THIS AGREEMENT CONTAINING COVENANTS AFFECTING REAL PROPERTY (the "Agreement Containing Covenants") is entered into this _ day of , 2007, by and between STRAIGHT TALK, INC., a California non-profit public benefit corporation ("Owner") and THE CITY OF SANTA ANA, a municipal corporation ("City"). 1. City is responsible for administration of certain funds ("HOPWA Funds") made available by the United States Department of Housing and Urban Development ("HUD".\ under the Housing Opportunities for Persons With AIDS Program (the "HOPWA Program". 2. For the purpose of effectuating the HOPWA Program, Straight Talk, Inc., has entered into the Grant Agreement for the acquisition of an eight bedroom home dated , 200 pursuant to which the City made a grant to Developer for the purchase of an AIDS Community Residence located in the City of Westminister, California, and more particularly described in Exhibit A attached hereto and incorporation hereby by this reference (the "Property"); and 3. pursuant Property. With the to the funds made available to Grant Agreement, Developer Developer by will purchase City the 4. The Grant Agreement contains certain provisions relating to the use of the Property with respect to which the parties have agreed to execute and record this Agreement Containing Covenants. NOW, THEREFORE, CITY AND OWNER COVENANT AND AGREE AS FOLLOWS: 1. Owner covenants and agrees (for itself , its successors, its assigns, and every successor in interest to the Property or any part thereof) that Owner, such successors, and such assigns shall devote the Property (or any part thereof), to the uses specified therefor in the Grant Agreement and this Agreement Straight Talk Development Agreement 7/18/2007 15 Containing Covenants. 2. Owner shall assure that the Property shall be used only for housing for Eligible Persons and their Families. a. related Family. "Eligible Person" shall mean a person with AIDS or a disease who is a low-income individual, and the person's b. "Family" shall mean a household composed of one or more related persons. The term "Family" also includes a person who is determined to be important to the care or the well-being of the Eligible Person, and the surviving member or members of any family described in this paragraph who were living in a dwelling unit on the Property with the person with AIDS at the time of his or her death. c. "Low- Income Individual" mean any individual or family whose income does not exceed 50% of the median income for the area, as determined by HUD, with adjustments for smaller and larger families, except that HUD may establish income ceilings higher or lower than 80% of the median for the area on the basis of HUD findings that such variations are necessary because of prevailing levels of construction costs or fair market rents, or unusually high or low family incomes. Notwithstanding the foregoing, the surviving member or members of a Family who were living in a dwelling unit on the Property at the time of the death of the person with AIDS may continue to occupy the Property for a period of up to 60 days following the death of the person with AIDS. 3. The rent charged by Owner for any dwelling unit within the Property shall be the higher of: a. 30% of the Family's monthly adj usted income (adj ustment factors include the age of the individual, medical expenses, size of family and child care expenses and are described in detail in 24 CFR 813-1020); or b. 10% of the Family's monthly gross income; or c. If the Family is receiving payments from welfare assistance from a public agency and a part of the payments, adjusted in accordance with the Family's actual housing costs, is specifically designated by the agency to meet the Family's housing costs, the portion of the payments that is so designated. Except for rent, Owner shall not charge any fee of any Eligible Person for any housing or services provided with HOPWA Funds. 4. Owner covenants and agrees for i tsel f, its successors, its assigns and every successor in interest to the Property or any part thereof, that there shall be no discrimination against or Straight Talk Development Ag:t:eement 7/18/2007 16 segregation of any person, or group of persons, on account of race, color, religion, national origin, sex, age, disability, mari tal status, sexual preference, creed, ancest ry, medical condition, Acquired Immune Deficiency Syndrome (AIDS), acquired or perceived, or retaliation for having filed a discrimination complaint, in the sale, lease, sublease, transfer, use, occupancy, tenure or enjoyment of the Property nor shall Owner itself, or any person claiming under or through it, establish or permit any such practice or practices of discrimination or segregation with reference to the selection, location, number, use or occupancy of tenants, lessees, subtenants, sublessees or vendees of the Property. 5. Owner shall file ",'ith City an Annual Report (herein referred to as the "Annual Peport") within sixty (601 days following the end of each calendar year, commencing with the end of the calendar year during which the acquisition of the Property is completed. The Annual Report shall include, and shall contain a certification with regard to, the rental rate and the income and family size of the occupants for each dwelling unit on the Property who have inhabited the Property during the previous calendar year. Owner shall obtain the income information required to be included in the Annual Report from the occupants of the Property. Any lease or other agreement that Owner requires occupants of the dwelling units on the Property to execute shall require the occupants to provide such income information upon the request of Owner. The Annual Peport shall contain a certification by Owner as to such other information as the Executive Director of Community Development or his designee may reasonably require. 6. In amplification and not in restriction of the provisions set forth hereinabove, it is intended and agreed that City shall be deemed a beneficiary of the covenants and agreements provided hereinabove both for and in its own right and also for the purposes of protecting the interests of the community. All covenants without regard to technical classification or designation shall be binding for the benefi t of City, and such covenants shall run in favor of City for the entire period during which such covenants shall be in force and effect, without regard to w'hether City is or remains an owner of any land or interest therein to which such covenants relate. Ci ty shall have the right, in the event of any breach of any such covenant or agreement, to exercise all the rights and remedies, and to maintain any actions at law or suits in equity or other proper proceedings to enforce the curing of such breach of covenant or agreement. 7. No violation or breach of the covenants, conditions, restrictions, provisions or limitations contained in this Agreement Containing Covenants shall defeat or render invalid or in any way impair the lien or charge of any mortgage or deed of trust or security interest on the Property, provided, however, that any subsequent owner of the Property shall be bound by such remaining covenants, conditions, restrictions, limitations, and Straight Talk Development Agreement 7/18/2007 17 provisions, ioreclosure, otherwise. whether deed in such J ieu owner's title of foreclosure... was acquired trustee's sale by or 8. Only City, its successors and assigns, and Owner and successors and assigns of Owner in and to all or any part of the fee title to the Property shalJ have the right to consent and agree to changes in, or to eliminate in whole or in part, any of the covenants, easements, or other restrictions contained in this Agreement Containing Covenants, or to subject the Property to additional covenants, easements or other restrictions. City, its successors and assigns, and Owner and the successors and assigns of Owner in and to all or any part of the fee title to the Property shall have the right to consent and agree to changes in, or to eliminate in whole or in part, any of the covenants, easements, or restrictions contained in this Agreement Containing Covenants or to subj ect the Property to additional covenants, easements, or other restrictions without the consent of any tenant, lessee, easement holder, licensee, mortgagee, trustee, beneficiary under a deed of trust, or any other person or entity having any interest less than a fee in the Property. 9. The covenants established in this Agreement Containing Covenants, shall, without regard to technical classification and designation, be binding on Owner and any successor in interest to the Property or any part thereof for the benefit and in favor of City, its successors and assigns, and City. The covenants contained in this Agreement Containing Covenants shall remain in effect for ten (10) years from the date on which this Agreement Containing Covenants was recorded. Straight Talk Development Agreement 7/18/2007 18 IN WITNESS WHEREOF, City and Owner have executed this Aqreement Containing Covenants on the date stated hereinabove. ATTEST: . // - 0~ Patriuia E. Healy Clerk of the Council APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney By: hi ~ [ ~_ ~ E. Storck Assistant City Attorney Straight Talk Development Agreement 7/18/2007 CITY OF David . Ream City Manager RECOMMENDED FOR APPROVAL: ~tephen . araing V Deputy C' y Manager for Development Services STRAIGHT TALK INC., A California Non-profit public benefit corporation ~'R_~ Bruce Robbins Executive Director 19 ACORD EVIDENCE OF PROPERTY INSURANCE I t1ATE ... 07.26.2007 THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE. AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY, PROOIICER I PHONE ~) 598-9701 COMPANY _(AlC....No~ CalCo.sllnsurance As.nay MARKEL INSURANCE COMPANY P.O. Box 1070 4050 Katona. Sulto 203 Los AI,mllos CA 90720 COPE: '-~~DE!: ~fY O.ME8.JO..#.:......-- INSURED LOAN NUMIIIR I POl.ICV Nu.,e~ Straight Talk Clinic Inc, 013656-DR 850255299540 5712 Camp str..l er:nCTlVE DATE I EX'PlRATlON DAlE JJ CON'llNUEO UN1lC ~1.2007 07-01.2008 ill TEiFtMINATEitllF= C~CI(EO Cypress CA 90630 TNIS RI!!PLA.CES PRIOR EVltJEHCE DA;'TI::D: I PROPERlY INFORMATION LCC"llONfDEScRIPTlON 13441 GOLllENWEST STREET WESTMINISTER , CA 92683 COVERAGE INFORM... TION eOVl!!RA(jIEtP~ILSlFDFtMS HOMEOWNERS (GUARANTEED REPLACEMENT COST 150 %) GENERAL LIABILITY 1 PREMIUM PAID IN FULL ~O~ <to ' ~\)~ ...'O~~O '?>....o'?-C~'(\e'l r",. t. I>-'l:t0 \.\'?>~ ~ C\-:l ~..\'I>'(\ ~ AMOUNTOFINSURANC~ 400,000 1,000,000 DEDUCTIBLE! 1000 o RE: FLOOD INSURANCE I COMPANY, FIDELITY NATIONAL I FROM: 07.17.2007 TO: 07.17.2008 I POLICH omOO048256 07 BUILDING $ 250,000 CONTENTS $ 30,000 DEDUCTIBLE $1,000, POLICY PAID IN FULL, CERTIFICATE HOLDER IS ADUlT/ONAL INSURED PER POLICY # 8502$$299540 "COVERAGE TO BE PRIMARY" CANCELLATION THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD, SHOULD THE POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYS WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW. ADDITIONAL INTEREST NAME AND ADDRess THE CITY OF BANTA ANA 20 CIVIC CETER PLAZA SANTA ANA, CALIFORNIA 92702 X MOR.TGAGEE X LOBS PA'!"EE COAN' 013656-DR X ADDITIONAlIt4SUR.ECI ATTN. JOHN 714-547-5411 ~CORD 27 (3/93) @A.CORO CORPORATION 1993