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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 />** The information below may be submitted in a separate spreadsheet attached to your application <br />Please include the minimum information below and name it Exhibit A— Property, Name ** <br />Property Name: <br />Property Address: <br />Tax ID for Payment: <br />Advanced Property Services Management, Inc. <br />14211 Yorba Street #200, Tustin, CA 92780 <br />36-4487885 <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 />Priscilla Sanchez <br />815 N. Figueroa St. #225, Santa Ana, CA 92706 <br />$ 1847.00 <br />Cung Le <br />815 N. Figueroa St. #214, Santa Ana, CA 92706 <br />$ 2225.00 <br />Jose Guerrero -Rico <br />923 N. Santiago #307, Santa Ana, CA 92701 <br />$ 2726.00 <br />Erica Miranda -Chavez <br />923 N. Santiago #201, Santa Ana, CA 92701 <br />$ 1260.00 <br />Emidio Catalan <br />923 N. Santiago #401, Santa Ana, CA 92701 <br />$ 754.34 <br />Jaime Sosa-Bautista <br />923 N. Santiago #402, Santa Ana, CA 92701 <br />$ 1438.34 <br />Abraham Lopez <br />300 E. Santa Ana Blvd. #123, Santa Ana, CA 92701 <br />$ 1158.88 <br />Federico Hernandez <br />300 E. Santa Ana Blvd. #322, Santa Ana, CA 92701 <br />$ 664.50 <br />Leonila Lopez -Lopez <br />326 S. Garnsey #102, Santa Ana, CA 92701 <br />$ 2011.66 <br />Octavio Roman <br />1030 S. Minnie St. #03, Santa Ana, CA 92701 <br />$ 707.30 <br />Fidel Lopez <br />1026 S. Minnie St. #06, Santa Ana, CA 92701 <br />$ 714.37 <br />Maria Vera <br />1030 S. Minnie St. #01, Santa Ana, CA 92701 <br />$ 702.75 <br />Rosalba Lopez <br />1025 S. Minnie St. #19, Santa Ana, CA 92701 <br />$ 702.75 <br />Manuel Lopez <br />1030 S. Minnie St. #07, Santa Ana, CA 92701 <br />$ 1083.00 <br />**See Exhibit A <br />Total Amount of Assistance <br />Requested <br />$47 620.30 <br />t <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 />