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Impacted Tenants List (Exhibit A) <br />This List will become Exhibit A of the Grant Agreement that you will enter into with the City of Santa Ana. <br />Households with a Housing Choice Voucher, also known as Section 8, or those who receive other <br />government rental assistance are not eligible. Tenants that you plan to evict are not eligible. It is your <br />decision to include which tenants qualify on this list. Please ensure you have: 1) a signed copy of the <br />Lease Agreement verifying occupancy for all tenants on the Impacted Tenants List for whom you are <br />seeking assistance; 2) documentation on file for all tenants on the Impacted Tenants List that <br />demonstrate that the tenant has been impacted by Coronavirus and have lost jobs, had their work hours <br />reduced, or have experienced a loss of income due to the economic or health impacts of Coronavirus and <br />who have been unable to maintain their rent payments under their lease agreements. Insufficient or <br />missing documentation may cause a delay in processing or, in some cases, a denial of the application. <br />Additional documentation maybe requested during the review of your application. 1 hereby attest that the <br />Impacted Tenants listed below will be released from any remaining obligation for any rent arrears owed <br />(20%) following payment by the City of Santa Ana (80%). <br />Property Name: Washington Place <br />Property Address: 1311 E Washington Place, Santa Ana, CA 92701 <br />Tax ID for Payment: 37-1754232 <br />Full Name of Tenant <br />(as stated on the Lease) <br />Address of Tenant's Rental Unit <br />Total Amount <br />of Rent Arrears <br />Owed <br />Lynzay Mendoza <br />1311 <br />E Washington Place Apt F4 <br />$ <br />1,310.00 <br />Orbelin Mendoza Diaz <br />1311 <br />E Washington Place Apt K4 <br />$ <br />4,877.00 <br />Satpal Singh <br />1311 <br />E Washington Place Apt K5 <br />$ <br />3,345.00 <br />Sonia Osorio Reyes <br />1311 <br />E Washington Place Apt L5 <br />$ <br />1,474.00 <br />Alfredo Escobedo Aguilera <br />1311 <br />E Washington Place Apt M1 <br />$ <br />3,294.00 <br />Jorge Ramirez <br />1311 <br />E Washington Place Apt M2 <br />$ <br />1,989.00 <br />Rosa Alvarez <br />1311 <br />E Washington Place Apt P3 <br />$ <br />4,600.00 <br />Leonardo Avila <br />1311 <br />E Washington Place Apt S3 <br />$ <br />5,477.22 <br />Luis Navarro <br />1311 <br />E Washington Place Apt S6 <br />$ <br />3,685.00 <br />Total Amount of Assistance <br />Requested <br />$ <br />30,05112 <br />Add additional pages if necessary. If you have multiple properties and you are unable to <br />accept payment on behalf of all of them, please list each property separately and provide the <br />name of the property at the top of each list. <br />Coronavirus Emergency Rental Relief Fund for Landlords Page 13 <br />Application <br />