NATIONAL HOUSING

TRUST FUND

APPLICATION

North Dakota Housing Finance Agency

2624 Vermont Ave

PO Box 1535

Bismarck, ND 58502-1535

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NATIONAL HOUSING TRUST FUNDAPPLICATION

PLANNING AND HOUSING DEVELOPMENT DIVISION

SFN 61097(08/16)

This is an application for financial assistancethrough the National Housing Trust Fund (HTF). The application must be signed and dated.

APPLICATION TYPE(check one)

Preliminary ReviewInitial ApplicationUpdated as of: Final Application

Allocation Year / Application Cycle (Deadline)
/ Application Date
/ Amount of HTF Assistance Requested

The applicant must fill out all applicable parts of the application form fully, including Exhibit A: Project Financial and Budget Spreadsheets, and include all documents and supplementary materials required. North Dakota Housing Finance Agency (NDHFA)staff is available to assist you prior to the submission of the application (Preliminary Review).

  1. GENERAL PROJECT INFORMATION
  1. Project Name and Location

Project Legal Name
Site Address
/ City
/ ZIP Code
/ County
Legal Description
  1. Project Activity(A narrative describing the project in detail must also be included.)

New construction of multifamily rental housing;

Substantial rehabilitation of existing uninhabitable housing;

Substantial rehabilitation (minimum $15,000 per unit) of habitablehousing at risk of becominguninhabitable due to deterioration;

Acquisition/Rehab (minimum $15,000 per unit) of existing multifamily rental property;

Adaptive Reuse of existing non-residential building(s) whichcreate new multifamily rental housing.

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Operating Cost Assistance is being requested in addition to the Project Activity indicated above.

2. APPLICANT AND OWNER INFORMATION

Applicant must be an eligible recipient of HTF funds. Eligible recipients include units of local, state, and tribal government, local and tribal housing authorities, community action agencies, regional planning councils, nonprofit organizations, and for-profit developers.

  1. Role of Applicant (check all that apply)

Developer Contractor SponsorOther (specify)

  1. Applicant

NDHFA awards HTF assistance to the Applicant listed on the initial application. Awards are not transferable without prior consent of the Agency.

Limited Partnership Limited Liability Co Non-Profit Corporation

General PartnershipLocal GovernmentHousing Authority

CorporationTribal Government Other (specify)

Is the Applicant seeking consideration under the HTF Indian Reservation Set-Aside? Yes No

Applicant WILL OR WILL NOTbe the final ownership entity.

Legal Name of Applicant / ApplicantFederal Taxpayer ID
Street Address
/ City
/ State
/ ZIP Code
Contact Person
/ Applicant Entity DUNS Number
Telephone Number / Email Address
/ Fax Number
If the Applicant will not retain ownership of the project, briefly describe the plan and timing for disposition.
  1. Final Project Ownership( Same as Applicant)

Limited Partnership Limited Liability Co Non-Profit Corporation

General PartnershipLocal GovernmentHousing Authority

CorporationTribal Government Other (specify)

Legal Name of Final Ownership Entity
/ Final Ownership Entity Federal Taxpayer ID
Street Address
/ City
/ State
/ ZIP Code
Contact Person
/ Final Ownership Entity DUNS Number
Telephone Number / Email Address
/ Fax Number
Once completed, what fiscal year will the project follow? (ex: “Calendar Year”; “July 1 to June 30”; etc.)
  1. Contact Person During the Application Process( Same as Applicant)

Name
Company
Mailing Address
/ City
/ State
/ ZIP Code
Telephone Number / Email Address
/ Fax Number
Capacity (i.e. Sponsor, Consultant, etc…)
  1. PROJECT CHARACTERISTICS

For purposes of this program, multi-family is defined as any project with four or more units intended as a rental.

  1. Type of Units

Apartments / Townhomes/Rowhomes / Detached / Other
  1. Site Information

Number of Sites / Site Area Size (in acres or square feet) / Current Zoning / Owned or Leased?

Check all utilities which are presently located up to or on the site:

Public Water / Private Well / Public Sewer / Private Septic / Electric / Natural Gas

Indicate any environmental factors present or in close proximity impacting this site, or “None”:

None / 100-yr floodplain / Airport / High tension wires / High noise level / Wetlands
Hazardous waste / RR tracks w/in 300ft / Industrial Site / Creek, river, or lake frontage
  1. Construction Type

Site-Built / Modular* / Panelized* / Other*
*If not site-built, provide manufacturer and manufacturing location:
Number of Residential Buildings / Number of Stories / Elevator
Yes No / Controlled Access/Security Building
Yes No

Check all other property characteristics:

Garage(s): / Carport(s): / Clubhouse / Maintenance Shed / Other

Universal Design per Scoring Category E of the HTF Allocation Plan ( Unit(s) = %)

  1. Square Footage Detail for Project

Total Residential Square Footage
Total Common Area Square Footage
Total Parking Structure Square Footage
Total Commercial Area Square Footage
Total Other Square Footage (specify)
Total Project Square Footage / 0
  1. Household Income Targeting of Units

Total number of residential units serving households at or below 30% area median income
Total number of residential units serving households above30% area median income, including market rate.
Total number of units in the project / 0
  1. Target Population of Units (Indicate all types and number of units)

Family ( Unit(s) = ) Disabled ( Unit(s) = )

Senior Restricted( Unit(s) = ) Homelessness ( Unit(s) = )

  1. Project-Based Rent Subsidies

Will the project be receiving any project-based rent subsidies? No Yes If yes, please indicate the numberof subsidized units and the date the subsidy was approved below.

Number of Units / Approval Date
USDA Rural Development
HUD Project-Based Vouchers
Other
  1. Anticipated Value

What is the anticipated value of the property after project completion?
Source to support anticipated value (please provide a copy of documentation)
Appraisal Tax assessed value Other (please explain)
  1. DEVELOPMENT TEAM
  1. General Contractor

Company Name
/ Contact Person
Mailing Address / City / State / ZIP Code
Telephone Number
/ Fax Number
/ Email Address
  1. Architect

Company Name
/ Contact Person
Mailing Address / City / State / ZIP Code
Telephone Number
/ Fax Number
/ Email Address
  1. Consultant

Company Name
/ Contact Person
Mailing Address / City / State / ZIP Code
Telephone Number
/ Fax Number
/ Email Address
  1. Property Management Company

Company Name
/ Contact Person
Mailing Address / City / State / ZIP Code
Telephone Number
/ Fax Number
/ Email Address
  1. Accountant

Company Name
/ Contact Person
Mailing Address / City / State / ZIP Code
Telephone Number
/ Fax Number
/ Email Address
  1. Attorney

Company Name
/ Contact Person
Mailing Address / City / State / ZIP Code
Telephone Number
/ Fax Number
/ Email Address
  1. Funding Sources

Name of Lender/Source
/ Contact Name
Mailing Address
City
/ State
/ ZIP Code
/ Telephone Number
Type Amortizing Loan Balloon Deferred Loan Forgivable Loan
Grant Owner Equity Other(specify) / Construction Financing
Permanent Financing
Name of Lender/Source
/ Contact Name
Mailing Address
City
/ State
/ ZIP Code
/ Telephone Number
Type Amortizing Loan Balloon Deferred Loan Forgivable Loan
Grant Owner Equity Other(specify) / Construction Financing
Permanent Financing
Name of Lender/Source
/ Contact Name
Mailing Address
City
/ State
/ ZIP Code
/ Telephone Number
Type Amortizing Loan Balloon Deferred Loan Forgivable Loan
Grant Owner Equity Other(specify) / Construction Financing
Permanent Financing
Name of Lender/Source
/ Contact Name
Mailing Address
City
/ State
/ ZIP Code
/ Telephone Number
Type Amortizing Loan Balloon Deferred Loan Forgivable Loan
Grant Owner Equity Other(specify) / Construction Financing
Permanent Financing
Name of Lender/Source
/ Contact Name
Mailing Address
City
/ State
/ ZIP Code
/ Telephone Number
Type Amortizing Loan Balloon Deferred Loan Forgivable Loan
Grant Owner Equity Other(specify) / Construction Financing
Permanent Financing
Name of Lender/Source
/ Contact Name
Mailing Address
City
/ State
/ ZIP Code
/ Telephone Number
Type Amortizing Loan Balloon Deferred Loan Forgivable Loan
Grant Owner Equity Other(specify) / Construction Financing
Permanent Financing
  1. PERMANENT SUPPORTIVE HOUSING

Will the project provide housing for individuals with special needs and offer supportive services to those tenants?

YesNo

If “Yes” above, how many units in the Project will be set aside and rented as permanent supportive housing to individuals with special needs?
  1. Indicate Population(s) to be Served

Chronic or persistently mentally ill
Frail elderly / Chemically dependent
Physically disabled / Developmentally disabled
Long-term homeless
  1. Provide a Detailed Explanation of the Supportive Services Provided
  1. Complete the Following for Each Supportive Service Provider(attach additional sheets if necessary)

Company Name
/ Contact Person
Mailing Address / City / State / ZIP Code
Telephone Number
/ Fax Number
/ Email Address
Company Name
/ Contact Person
Mailing Address / City / State / ZIP Code
Telephone Number
/ Fax Number
/ Email Address

Will participation in supportive services be mandatory for your tenants? Yes No

Do monthly rents include the cost of the supportive services? Yes No

Will the property be staffed by Services Personnel 24 hours per day?Yes No

(“Services Personnel” does not include maintenance or security staff.)

The following must be provided with this application:

Support for the need for the special type of permanent supportive housing based on market demand, the current North Dakota State Consolidated Plan (citation only please, not the entire Plan), and the findings of the local social service agency or ND Department of Human Services regional service center;

Third-party verification of the services appropriate to the targeted population;

A formal letter of intent between the owner and a qualified and experienced service agency/agencies to provide on-going services consistent with the needs of the targeted population;

Evidence that the building and unit configurations meet the specific needs of the targeted population; for the physically disabled, this includes accessibility features that may exceed the ADA standards but make a project more functional for people with a disability;

Certification from an architect or the Applicant that the accessible units and common areas meet or exceed Federal Fair Housing Accessibility Guidelines. (Only required for projects serving individuals with physical disabilities.)

  1. PROJECT TIMETABLE
  1. Provide the Following Project Milestone DateEstimates / Actualsfor the Project

Activity / Date (MM/DD/YY)
Acquisition
Zoning / Plat Approval
Tax Abatement Approval
Environmental Review Start
Site Plan Approval
Building Permit
Closing and Disbursement of Bridge or Pre-Development Financing
Closing and Disbursement of Construction Financing
Construction Start
Construction Completion
Start Lease-up / Rent-up of Rental Units
Stabilized Occupancy of Rental Units
Closing and Disbursement of Permanent Financing
  1. NOTES AND OTHER INFORMATION

Please provide in this space any additional or clarifying information.

  1. APPLICANT CERTIFICATIONS
  1. The Undersigned Hereby Acknowledges the Following:
  1. That this application and all Exhibits provided by NDHFA to applicants for funding, including all sections herein relative to project costs, operating costs, and determinations of the amount of assistance necessary to make the project financially feasible, is provided only for the convenience of NDHFA in reviewing applications; that completion hereof in no way guarantees eligibility for the funding; and that any notations herein describing the requirements are offered only as general guides and not as legal authority;
  2. That the undersigned is responsible for ensuring that the proposed project will, in all respects, satisfy all applicable requirements of the HTF program and any other requirements imposed upon it by NDHFA at the time of commitment, should one be issued;
  3. That NDHFA may request or require changes in the information submitted herewith, and may substitute actual figures for any estimated figures provided therein by the undersigned and may commit assistance, if any, in an amount different from the amount requested;
  4. That commitments are not transferable without prior approval by NDHFA;
  5. That the requirements for applying for assistance and the terms of any commitment thereof is subject to change at any time by federal or state law, federal, state or NDHFA regulation, or other binding authority; and
  6. That a commitment will be subject to certain conditions to be satisfied prior to closing and disbursement of funds.
  7. That the undersigned provides NDHFA the right to exchange information with other parties as deemed appropriate by NDHFA.
  1. Further, the Undersigned Hereby Certifies the Following:
  1. The applicant shall not, in the provision of services, or in any other manner, discriminate against any person on the basis of race, color, creed, religion, sex, national origin, age, familial status or handicap; and
  2. The applicant shall ensure that all construction complies with the accessible and adaptive design and construction requirements of the Fair Housing Act; and
  3. That, to the best of its knowledge and belief, all information provided herein or in connection herewith is true and correct and all estimates are reasonable and can be obtained from any source named herein; and
  4. That it will at all times indemnify and hold harmless NDHFA against all losses, costs, damages, expenses, and liabilities of any nature or indirectly resulting from, arising out of or relating to NDHFA’s acceptance, consideration, approval, or disapproval of this request and the issuance or nonissuanceof HTF assistance in connection herewith; and
  5. That HTF funds will be used for eligible activities and costs, as described in 24 CFR 93.201 and 93.202, and will not be used for prohibited activities, as described in 24 CFR 93.204.
  6. That all eligible HTF-assisted housing units will comply with all HTF requirements.
  7. That the following selected criteria, for which the applicant is seeking competitive points, will apply to the proposed project seeking HTF assistance:
  8. The period of affordability shall exceed the minimum of 30 years by years.
  9. At least percent of the total development cost shall be financed by non-federal fundingsources, in accordance with Scoring Criteria C of the HTF Allocation Plan.
  10. At least low income units shall be set aside and rented to, and suitable services provided to, persons with special needs in accordance with Scoring Criteria D of the HTF Allocation Plan.

Such special needs project will be staffed 24-hours per day by services personnel.

  1. The development qualifies for design standard points.

Elevator

2 stories or less and no more than 4 units per outside entrances

2 stories or less and a separate outside main entrance for each unit

  1. Development will have 20% or more of the extremely low-income units which are three bedroom or larger.
  2. At least low income units shall meet the Universal Design standards in accordance with Scoring Criteria E of the HTF Allocation Plan.
  1. THAT THE APPLICANT, DEVELOPER, SPONSOR, CONTRACTOR, OR ANY OTHER MEMBER OF THE DEVELOPMENT TEAM, INCLUDING ANY OF THEIR OWNERS, PARTNERS, OR BOARD MEMBERS HAVE BEEN CONVICTED OF, ENTERED AN AGREEMENT FOR IMMUNITY FROM PROSECUTION FOR, OR PLEAD GUILTY, INCLUDING A PLEA OF NOLO CONTENDERE, TO A CRIME OF DISHONESTY, MORAL TURPITUDE, FRAUD, BRIBERY, PAYMENT OF ILLEGAL GRATUITIES, PERJURY, FALSE STATEMENT, RACKETEERING, BLACKMAIL, EXTORTION, FALSIFICATION OR DESTRUCTION OF RECORDS, NOR ARE THEY CURRENTLY DEBARRED FROM CONTRACTING OPPORTUNITIES BY ANY AGENCY OF THE FEDERAL OR STATE OF NORTH DAKOTA GOVERNMENTS.

IN WITNESS WHEREOF, the undersigned, being a duly authorized agent of the Applicant, has caused this document to be executed in its name on thisday of , 20.

I declare and affirm under the penalties of perjury that the information contained in this application is, to the best of my knowledge and belief, in all thingscomplete, true, and correct.

Print Legal Name of Applicant / By (Print Name of AuthorizedRepresentative) / Title
Signature / Date

North Dakota Housing Finance Agency • 2624 Vermont Ave • PO Box 1535 • Bismarck, ND 58502-1535 SFN 61097
Ph: 701/328-8080 • Fax: 701/328-8090 • Toll Free 800/292-8621 • 800/366-6888 (TTY)Page 1 of 9

NATIONAL HOUSING TRUST FUNDAPPLICATION CHECKLIST

Submit the following items as part of the North Dakota Housing Trust Fund (HTF) application package. If an item is not available at the time of application, provide anexplanation and an estimated date for when the item will be available for submission; score deductions may apply. “Threshold Requirements”referred to below are those found in Section V of the HTF Allocation Plan.

Completed National Housing Trust Fund Application, signed by authorized person;

Exhibit A to the HTF Application: Project Financial and Budget Spreadsheets(Threshold Requirement F)

Detailed narrative about the project including, at a minimum, the following information:

Summary description of the project Explanation of need/market demand

Plan for management of the propertyHowproposed rents were determined

Experience in creating, owning, and managing multifamily rental property (Threshold Requirement A)

Experience in compliance with federal housing funding program(s) including all applicable cross-cutting

requirements. (Threshold Requirement A)

Plan for timely unit lease-up and for marketing the HTF units to eligible households as well as the application and selection process to be used (Threshold Requirement J)

Organizational documents of the applicant and final project owner (i.e. partnership agreements, articles of incorporation or organization, by-laws or operating agreement, or enabling statute)

Certificate of Good Standing from the North Dakota Secretary of State

Proof of Federal Taxpayer Identification Number (IRS Form W-9 or SS-4)

For non-profit applicants, proof of IRS for designation as a 501(c)(3) or 501(c)(4) organization

For non-profit applicants, the Articles of Incorporation must contain a purpose statement which includes a provision to provide decent housing that is affordable for low- and moderate-income persons

A list of all Board Members and their term expirations, and Executives of the applicant entity

Authorization or resolution to borrow by the applicable governing body of the applicant entity

Support for utility allowances presented inthe HTF Application Exhibit A, Operating Budget tab

Current year-to-date and the previous two years of financial statements for the property (existing rental housing properties only)