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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 may be requested during the review of your application. I 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: California Palms Apartments <br />Property Address: 901 S. Harbor Blvd, Santa Ana, CA 92704 <br />Tax ID for Payment: 33-0592589 <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 />Antonio Cruz Delgado <br />801 S Harbor Apt 100 <br />$ 2,925.00 <br />Andre Butler <br />801 S Harbor Apt 125 <br />$ 2,650.00 <br />Mary Ann Alcansare <br />801 S Harbor Apt 133 <br />$ 2,554.68 <br />Rufus Johnson <br />801 S Harbor Apt 144 <br />$ 1,625.00 <br />Malik Kadir <br />901 S Harbor Apt 225 <br />$ 2,863.50 <br />Stacy Patriarca <br />901 S Harbor Apt 232 <br />$ 2,125.00 <br />Renee Rocha <br />905 S Harbor Apt 321 <br />$ 1,943.00 <br />Reese Nakagawa <br />905 S Harbor Apt 351 <br />$ 1,732.00 <br />Sheyanna Walters <br />905 S Harbor Apt 354 <br />$ 1,153.00 <br />Total Amount of Assistance <br />Requested <br />$ 19,571.18 <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 <br />Application <br />Page 13 <br />