Section I - Agency Information

Organization/Agency Name: / Employer Federal I.D. Number:
Website: / Faith Based Organization?
Yes No
Mailing Address: / City: / State: / Zip:
Telephone: / Fax: / DUNS: / CCR:
Are you a non-profit organization? / YES NO
Has this organization received commitment of federal fundsin the past?
Has this organization received Project-Based Vouchers in the past? If yes, how many?______ / YES NO
YES NO
President/Director / Project Administrator / Finance Officer
Name:
Title:
Address:
Phone:
Fax:
E-Mail:

Section II - Project Information

Name of Project:
Location of Project: / Census Tract(s):

Section III - Project Funding Sources(also complete included financial worksheet)

PROJECT-BASED VOUCHERS
REQUESTED THIS APPLICATION
Project Funding
OTHER FEDERALFUNDS
OTHER CITY FUNDS
STATE FUNDS
PRIVATE FUNDS
OTHER – LIHTC Equity,etc.
DHNP Capital Grant Funds Requested
TOTAL

Section V –Completion Checklist

Each applicant must indicate if they possess the items indicated below.
They will be required to be submitted to DHNP if their project is funded.
YES / NO / On File / N/A
  1. Application Completed & Signed Certification

  1. Articles of Incorporation and Bylaws

  1. State and Federal Tax Exemption Determination Letters

  1. Federal Employment Identification Numbers

  1. List of Board of Directors, their Titles and Contact Information

  1. Board of Director’s Designation of Authorized Official

  1. Most Recent Organization Chart

  1. List of Previous Housing Developments

  1. Financial Statement and Most Recent Audit Report

  1. Matching Funds Commitments Documentation

  1. List of Collaborative Partners and their role

  1. 504 Self Evaluation Plan (Americans with Disabilities Act) Agencies with 15 Employees or More

  1. Project Implementation Timeline & Additional Outcome Objectives

  1. Are your DUNS and CCR numbers on file?

Section VI - Agency Narrative & Project Description

  1. Provide Project Information and Analysis in the chart below:

Item / Amount / Explanation
Total housing units to be created or rehabilitated
Number of units to receive Project Based Vouchers
Total 1 BR units
Total 2 BR units
Total 3 BR units
Term of Contract Requested
# of Units to be affordable at
30 % or below of AMI
31-50% of AMI
51-80% of AMI
81-120% of AMI
# of households by type to be served:
Seniors (state minimum age)
Veterans
Homeless
Disabled
Other/multiple categories (describe)
Total Project Cost
Total project cost/unit
Building cost only (exclude site, predevelopment, developer fee, etc)
Building cost/unit
Debt coverage ratio if applicable
Proposed total debt/unit
Proposed total developer fee, if any
List other public or subsidized funding and amounts
List any funding from foundations and amounts
  1. Describe the site location and community amenities, i.e. Distance to shopping, public transportation, proximity to hospitals, clinics, schools, recreational facilities, etc.

  1. Describe the project design (number of floors, elevations, architectural elements, room sizes, on-site amenities, laundry facilities, etc. Include drawing, picture and renderings if available.

  1. Describe the organization’s development experience and capacity to carry out the project. Especially relevant is experience completing the same activity as you are requesting funds for. Include information about the financial capacity of your organization, and the number of years owning and managing affordable housing.

  1. Describe the project’s feasibility and readiness to commence construction. Include information regarding other financing in place, and please attach a market study for the project, if available.

  1. Describe how the project is consistent with the city’s Consolidated Plan, Ten-Year Plan to End Homelessness, or other applicable plan.

  1. Summarize the key reasons, if not already stated above, that this project should be funded.

Section VII-Budget

  1. Provide the basic project financial information on the separate finance worksheet. Provide any necessary narrative to fully explain the figures in the space below.

Please note that the following information must be provided upon DHNP’s decision to approve an award under this RFP. This information is necessary to complete the required Subsidy Layering Review.

  1. Sources and Uses of Funds Statement

Sources: List each source separately, indicate whether loan, grant, syndication proceeds, contributed equity, etc. Sources should generally include only permanent financing. If interim financing or a construction loan will be utilized, details should be included in a narrative (item 3 below).

Uses: Should be detailed. Do not use broad categories such as “soft costs.” Acquisition costs should distinguish the purchase price from related costs such as appraisal, survey, titled and recording, and related legal fees. Construction and rehabilitation should include builder's profit and overhead as separate items.

  1. Narrative describing details of each funding source. For loans, details should include principle, interest rate, amortization, term, and any accrual, deferral, balloon or forgiveness provisions. If a lender, grantor, or syndicator is imposing reserve or escrow requirements, details should be included in the narrative. If a lender will receive a portion of the net cash flow, either as additional debt service or in addition to debt service, this should be disclosed in the narrative.
  2. Commitment Letters from lenders or other funding sources evidencing their commitment to provide funding to the project and disclosing significant terms. Loan agreements and grant agreements are sufficient to meet this requirement.
  1. Appraisal Report. The appraisal should establish the “as is” value of the property, before construction or rehabilitation, and without consideration of any financial implications of tax credits or project-based voucher assistance. An appraisal establishing value after the property is built or rehabilitated is not acceptable unless it also includes an “as is” valuation.
  1. Stabilized Operating Proforma. Should include projected rental, commercial, and miscellaneous income, vacancy loss, operating expenses, debt service, reserve contributions and cash flow. The analysis must be projected over a 15 year period. Income and expenses must be trended at ____ percent. (Must reflect current trend.)
  1. Tax Credit Allocation Letter. Issued by the State tax credit allocation agency, this letter advises the developer of the amount of LIHTCs reserved for the project.
  1. Historic Tax Credits. Some projects in designated historical districts may receive an additional one time historic tax credit. When applicable, the amount of the historic tax credit should be disclosed. (If Applicable)
  1. Equity Contribution Schedule. If equity contributed to the project will be paid in installments over time, a schedule should be provided showing the amount and timing of planned contributions.
  1. Bridge Loans. If the financing plan includes a bridge loan so that proceeds can be paid up front when equity contributions are planned over an extended period, appropriate details should be provided.
  1. Standard disclosure and perjury statement
  1. Identity of Interest Statement
  1. PHA commitment letter for project-based voucher assistance
  1. Proposed project-based voucher gross rent amounts

SectionVIII -Statement of Applicant

The undersigned acknowledges the following:

  1. That, to the best of its knowledge and belief, all factual information provided is true and correct and all estimates are reasonable.
  2. That this request may be forwarded for consideration under other budget processes if it is determined that alternative sources may be appropriate.
  3. That no revised proposals/applications may be made in connection with this application once the deadline for applications has passed.
  4. That the applicant will participate in required interview for project assessment and cooperatively assist in the review process.
  5. The City of Virginia Beach reserves the right not to fund any submittals received.
  6. By submission of this application, the organization agrees to abide by the federal regulations applicable to this program.
  7. That, if the Project Based Vouchers are provided, the organization agrees to abide by the City’s locally established policies and guidelines
  8. That past program and financial performance will be considered in reviewing this application.
  9. That, if the Project Based Vouchers are provided, the City or a designated agency may conduct an accounting system inspection to review internal controls, including procurement and uniform administrative procedures, prior to issuance of payments for projected expenditures.
  10. That, if the Project based Vouchers are provided, the City will perform an environmental review prior to the obligation of funds.
  11. That, if the Project based Vouchers are provided, a written agreement that includes a statement of work, records retention and reporting, program income procedures, local and federal requirements, circumstances that would trigger grant suspensions and terminations, and reversions of assets may be required between the organization and the City.
  12. Provide written signatory authority from the organization’s governing body indicating who can execute contracts and amendments on its behalf.
  13. Agrees to abide by the City of Virginia Beach’s Conflict of Interest policy. Items of concern would include staff members serving on the Board of Directors, staff members’ families serving on the Board of Directors, and other matters that may give the appearance of a conflict of interest.
  14. Agrees to comply with the following: 24 CFR Parts 982 and 983,where applicable, Fair Housing Act, Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990, Davis Bacon Act, Section 3 and other Federal Regulations.

PENALTY FOR FALSE OR FRAUDULENT STATEMENT
U.S. Code Title 18, Section 1001, provides that a fine of up to $10,000 or imprisonment for a period not to exceed five years, or both, shall be the penalty for willful misrepresentation and the making of false, fictitious statements, knowing same to be false.

By signature below, the applicant acknowledges the above on this _____day of ______, 2012.

Signature / Title / Organization

Due By October 30, 2012 at 4:30 p.m.Page 1 of 9