APPLICANT INSTRUCTIONSAND CHECKLIST For

APPLICANT INSTRUCTIONSAND CHECKLIST for

SHELTER PROJECTSand

SMALL-SITE ACQUISITIONHOUSING PROJECTS (PERMANENT OR TRANSITIONAL)

FOR SPECIAL NEEDS POPULATIONS

Please review the County’s Affordable Housing Fund (AHF) Funding Policies & Guidelines

and these instructions beforesubmitting your application.

PRE-APPLICATION PROCESS:

Applicants for Shelter Projects and Small-Site Acquisition Housing Projects (Permanent or Transitional) for Special Needs Populations will submit applications through an “over-the-counter” process described below.

 Prior to submitting an application, ALL prospective applicants are encouraged to discuss their proposed project with Department of Housing (DOH) staff. Applicants may discuss a proposed project with DOH staff even before site control or site identification is accomplished, and may submit an application prior to achieving site control.

To schedule an appointment, please see “Submitting the Application” on page 2 of these instructions.

ELIGIBILITY FOR FUNDING:

Applications must include complete answers to all applicable questions ANDall required attachments (see section below) to be deemed eligible for funding.

All applications must meet ALL of the QualificationCriteria found in theCounty’s Affordable Housing Funds (AHF) Funding Policies & Guidelines, posted on the Department of Housing website as part of this NOFA.

APPLICATION FORMAT:

Applicants must use this funding application. All responses to questions should be typed, single-spaced, using not less than 11 point font, on the Word versionof the application using 1 inch margins. Please keep your responses brief while still adequately addressing the questions. Please do not double-side your application, change the order of the questions or change the formatting. Place Attachments and supplemental materialsat the end, after the application form.

Do not have applications bound. Please use only clips or binders with tabs to indicate sections.

Complete the entire application. Your application will be reviewed on the basis of the information you provide. Supplemental materials must be kept to a minimum. Attachments and supplemental materials must be on 8 1/2 x 11-inch paper (except for items noted in Checklist that may be on 8 ½ x 14-inch paper). Larger sized paper and excessive supplemental materials will not be reproduced for review by the reviewing committeeand Board of Supervisors.

REQUIRED APPLICATION ATTACHMENTS:

A resolution from the Board of Directors that authorizes the submittal of the application must be attached. Applications from non-profit agencies will not be eligible for funding consideration without a Board of Directors resolution.

The IRS Letter of Determination must be attached to the application for all non-profit agencies applying for funding. You will not be eligible for funding consideration unless non-profit status has been obtained and verified.

Evidence of Site Control (if Site Control achieved).

Site location map (if Site Control achieved).

A Development Budget.

Financing Commitment letters – if any.

15-Yr Cash Flow Projection for the project.

Acertified financial audit no more than 1 fiscal year old, prepared by a CPA, and: Managementletters (if applicable); A-122 and A-133 Single Audit (for entities that receive more than $500,000 in federal funding) OR a letter from your Executive Director certifying that the agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit.(Note: NOT required if these items have been submitted to the County Housing Department in conjunction with another funding application during the past year)

ADDITIONAL APPLICATION ATTACHMENTS AS AVAILABLE AND SUPPLEMENTAL MATERIALS:

Preliminary Title Report

Property Appraisal

Estimated Rehabilitation Costs (if Acquisition/Rehab)

Financing commitment letters

Sponsor experience

Owner experience

Property Manager experience

Services Provider experience

SUBMITTING THE APPLICATION:

Please see “Pre-Application Process” instructions above. Applicants are encouraged to discuss their proposed project with DOH staff in order to get helpful feedback prior to formally submitting an application. To schedule a pre-application discussion of your project, please call Janet Stone, Housing Policy & Development Manager, at (650) 802-3396 or email her at

All submitted applications must contain all required information and be submitted to the San Mateo County Department of Housing.

Applications may be submitted anytime between September 1, 2013 and March 31, 2014to be considered eligible for County AHFfunding. Please call or emailDenise Milner (see below) to schedule a date/time when the application will be submitted so that your application can be received and date-stamped.

Submit 1hard copyoriginal with a complete set of attachments – all unbound to the San Mateo County-Department of Housingat 264 Harbor Blvd, Building A, Belmont, California 94002.

Submit 1 electronic word version application with any extra pages and all attachments as pdf’s,to:.

ContactDenise Milner at the San Mateo County Department of Housing, at (650) 802-5048or by email at if you have any questions about the application form or submission requirements.

San Mateo County AHF -- Application Instructions 8/30/13

County’s Affordable Housing Fund (AHF) FUNDING APPLICATION

SMALL-SITE ACQUISITION HOUSING PROJECTS (PERMANENT ORTRANSITIONAL) FOR SPECIAL NEEDS POPULATIONS

Application Summary Sheet

Applicant: Legal Name of Organization/Legal EntityProject Name

Organization Executive Director: Name, Title & Email address
Contact Person (if other than ED) Name, Title & Email address

Authorized Signatory for Loan Documents: (if other than ED) Name, Title & Email address

Mailing Address of Organization

TelephoneEmailOrganization website address

Date: ______Tax ID #:

Amount
Requested: $ Total Development Cost: $

Type of Project (check all that apply):Permanent Housing Transitional Housing

Shelter (Emergency) Shelter (Transitional)Shared Housing

Group Home/Congregate Scattered Site

(DOH Only) Date and Time Received

Project Summary

Name of Project:

Project Location/Address:

Project Planning Jurisdiction

(Check all that apply)
Site Acquisitionof Existing Structures for Small-Site Housing or Shelter,with NO

Rehabilitation required[repairs and/or refurbishing and/or minor modifications with total

cost of less than $10,000 are not considered rehabilitation]

Site Acquisition and Rehabilitation of Existing Structures for Small-Site Housing or Shelter

Site Acquisition for new Shelter Development (with no existing Structures that will be used)

Shelter Renovations and /or Expansion

Offsite Improvements

Demolition
PredevelopmentActivities (other than Site Acquisition)
Relocation (Occupants or Businesses)

For the Completed Small-SiteAcquisition Housing Project:

Total # of Units: Total # of Residents at full Occupancy:

(a lockable bedroom isequivalent to a unit)

Total Development Cost: $Funds Requested: $

For the Completed Shelter Project:

Total Shelter size (square feet): Total # of Residents at full Occupancy:

Total Development Cost:$Funds Requested:$

Summary Project Description:

This section will be incorporated into the staff reports provided to the Advisory Committee and the Board of Supervisors.
Descriptions MUST BE75 words or less.

I.Detailed ProjectDescription
Provide a narrative description of your project including:

(a) Proposed use(s) of the requested funding;

(b) Type of housing/ shelter proposed and the target population(s) served;

(c) Status of site control (or if there is no site control, your site identification plan/strategy);

(d) Planning permits/ approvals needed, if any, for the site;

(e) Other financing commitments proposed / obtained for either the acquisition phase or for ongoing operations.

II.Services

For Small-Site Acquisition for Permanent Housing, describe the services that will be provided on-site, or linked to the project, to assist residents to maintain their housing and live as independently as possible. Please indicate if you have any MOUs in place with any of these service providers if services will be provided by other organizations.

For Small-Site Acquisition for Transitional Housing OR Shelter facilities, describe the services that will be provided on-site, or linked to the project, to assist residents to stabilize andtransition to other housing and maintain that housing. Please indicate if you have any MOUs in place with any of these service providers if services will be provided by other organizations.

For either of the above, please attach a Services Plan if available

III.Sources of Funding for Services and Operations

Describe the sources of funding that will be used for services and overall operations costs of the project. If there will be operating subsidies for the project, indicate if these are project-based, tenant-based, or sponsor-based.

IV.Project Timeline
Include all major milestonesup to initial occupancy of the housing, such as: obtaining necessary funding commitments,completing MOU’s with partners, site acquisition, obtaining zoning or use permits (if applicable),rehabilitationcompletion (if applicable), initial occupancy.

Please provide realistic dates for completion of activities and expenditure of funds. These dates will be included in the Sponsor Funding Agreement and will be revised only with the consent of the Department of Housing.
ACTIVITYTARGET COMPLETION DATE

V. AHF Funds Expended by Development Activity

Please provide an estimate of the amount of AHF funds that will be spent for the following:

1.Predevelopment activities other than Site Acquisition:

2.Site Acquisition:

3.Relocation of existing occupants:

4.Rehabilitation / Renovations:

5.New construction (Shelter only):

VI.Project Team (if any entities are unknown at this time, state “Unknown”)

1. Sponsor:Name:
Address:
City, State, Zip:
Contact Person:
Telephone: Email Address:
Nonprofit For-Profit

2. Owner:Name:

Address:
City, State, Zip:
Contact Person:

Telephone: ______Email:
Nonprofit For-Profit

3. RehabName:

ContractorAddress:

(if applicable)City, State, Zip:
Contact Person:
Telephone: License No.

4. PropertyName:

ManagerAddress:
City, State, Zip:
Contact Person:
Telephone: Email Address:

5. Resident

ServicesName:

ProviderAddress:
City, State, Zip:
Contact Person:
Telephone: Email Address:

6. Supportive

ServicesName:

Provider (if

applicable)Address:

City, State, Zip:
Contact Person:
Telephone: Email Address:

VII.Experience and Capacity of Key Parties

Briefly describe the experience and capacity of key project parties, including the Sponsor,Owner (if different), Property Manager, and Service Provider(s). If desired, attach supplemental materials providing additional information about the key parties’ experience/capacity.

VIII.Site Information

(Check the applicable box)

NO site identified (therefore information below is left blank)

Site(s) identifiedbut no site control (fill out information for identifiedsite(s)

Site control achieved (fill out site information for site(s) having site control)

1.Number of parcels, Address(es) and Assessor’s parcel number(s):

Census Tract:
Attach current Preliminary Title Report, if available.

2.Size(s) of the parcel(s):

3.Total number of residential units proposed (lockable bdrm is equivalent to a unit):

4.Status of Site Control: Identify the applicant’s form of site control (whether ownership, purchase agreement, lease, or option agreement), the dates of any key expectations (e.g. when a purchase agreement expires) and the applicant’s current access to each parcel.
Attach Site Control documents, if available.

5.What is the current use of the site?

6.Is the site, or any part of it, within a 100-year floodplain?
List FIRM Map number:

7.Do you have a current appraisal for the site? Yes No

Attachcopy of a current appraisal, if available*.
* The appraised value must fully secure the County’s loan(s). In addition, the total purchase price may not exceed the “reasonable cost” for the property.

8.a.Which jurisdiction(s) must approve the project?

b.What local planning approvals/permits will be required for the proposed project?

1. Describe the status of the local approvals or permits:
   

9.a.Will the project involve demolition of existing structures or relocation of residential or business occupants?

If yes, explain status of these activities:
b.If relocation of residents is necessary, is there replacement housing available? Please explain

10.a.How will water and sewer service be provided?

11.Existing Improvements:

Residential Commercial/Industrial

Number of Structures
Approx.Year Built
Number of Vacant Structures
Number of Occupied Structures
Number of Structures to be Demolished
Estimated Cost of Relocation

12. Green Building: If you will be doing major repairs or rehabilitation, or replacing appliances, please specify how you intend to incorporate Green Building materials/ methodology into your project.

IX.Occupancy/ Revenues / Resident Charges

1.Proposed Occupancy for Small-Site Acquisition Housing (Transitional or Permanent):

Unit Type / Bed-room / SRO unit / Studio / 1-BR / 2-BR
Average Square Feet Per Unit (or lockable bedroom if shared housing / group home)
# of Resident units by unit size
Manager unit
TOTAL NUMBER OF UNITS:
Rents and Subsidies
Indicate monthly rental rate (if any) by unit size / $ / $ / $ / $ / $
Indicate total monthly operating subsidy by unit (if any) / $ / $ / $ / $ / $
Indicate total services program funding by unit (if any) / $ / $ / $ / $ / $
Other (specify: _ ) / $ / $ / $ / $ / $
TOTAL MONTHLY REVENUE (before vacancy loss) / $ / $ / $ / $ / $

2.For Shelters OR Small-Site Acquisition Housing (Transitional or Permanent) -- will there be any charges or expenses over-and-above a rent payment (if any) that will be the responsibility of the residents (e.g. utilities, deposits, mandatory savings accounts, etc.)?

X. Affordability Restrictions

1. What is the proposed length of affordability for the project?

______Years

1. Do any of your other anticipated funding sources impose affordability restrictions?

Yes_____ No______

Please describe these other affordability restrictions

XI.Development Budget

Estimated Predevelopment, Site Acquisition and Rehabilitation (if any) Financing:

Lender / Amount / Interest Rate/Term / Use(s) / Commitment Status
Total Amount:

Estimated Permanent Financing:

Lender / Amount / Interest Rate/Term / Use(s) / Commitment Status
Total Amount:

Attach an itemized development budget, showing Sourcesand Uses of Funds Table.

Attach copies of any financing commitment letters.

XII.Summary of First Year Operating Budget

TotalPer Unit

Gross Potential Rental Income$______$ ___

plus other Operating/Services Revenue$______$ ___

plus other Income (e.g. laundry)$______$ ___

less _% Vacancy/Rent Loss($__ ) ($ ___)

Effective Gross Income$______$ ____

lessTotal Operating Expenses($______) ($ ___)

less Payment to Replacement Reserves($____ ) ($ ___)

lessPayment to Other Reserves($______) ($ ___)

Net Operating Income ($______$ ____

lessDebt Service Payments($ ) ($ ____)

Net Cash Flow$ $

Distributions$______$______

Attach a 15-year operating budget and cash flow projection that shows estimated project income, operating expenses, reserves, debt service and distributions.

XIII.Checklist

Attach the following items. Please check box if attached.

* 1.Corporate Borrowing Resolution authorizing submission of this funding application (check one):

* 2.IRS 501 (c)(3) Determination letter (non-profits only)

* 3.Evidence of Site Control(if site control has been achieved).

* 4.Site Location Map (if site is identified)

5.Preliminary Title Report.

6.Appraisal.

7.Services Plan, describing the on-site and off-site services that will be available to

the residents.

8.Supplemental information on Key Parties Experience/capacity (Sponsor, Owner, PropertyManager, Resident Services Provider, Other Services Provider(s))

* 9.Development Budget (Table showing Sources of Funds & Uses of Funds).

* 10.Financing Commitment Letters, if any.

* 11.15-Year Cash Flow Projection for Project.

* 12.Certified financial audit no more than 1 fiscal year old, prepared by a CPA, and:

• Management letters (if applicable)
• A-122 and A-133 Single Audit (for entities that receive more than $500,000 in federal funding) OR
• A letter from your Executive Director certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit.

(Note: NOT required if these items have been submitted to the County Housing

Department in conjunction with another funding application this year)

*MANDATORY ATTACHMENTS. THESE ITEMS MUST BE SUBMITTED FOR APPLICATION TO BE ELIGIBLE FOR FUNDING CONSIDERATION.

San Mateo County AHF – SMALL-SITE ACQUISITION HOUSING APPLICATION

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