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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 rile 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, Insufficientor
<br />missing documentation may causea delay in processing or, in some cases, a denial of the application.
<br />Additional documentation maybe 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 />Harbor Pointe Apartments
<br />1500 N. Harbor Blvd. Santa Ana, CA 92703
<br />33-0741412
<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 />Juan C. Rodriguez, AHansa Rod,... Miguel Hernandez
<br />1500 N. Harbor Blvd. #A-04 Santa Ana, CA 92703
<br />$ 6,037.50
<br />Teodoro Rios, Ameli Salinas
<br />1500 N. Harbor Blvd. #B-02 Santa Ana, CA 92703
<br />$ 2.230.00
<br />Erica Garcia, Antonio Martinez
<br />1500 N. Harbor Blvd. #B-04 Santa Ana, CA 92703
<br />$ 3,400.00
<br />Rebecca AAla. Hemn AvOa, Diana Mondmgon Ramimz
<br />1500 N. Harbor Blvd. #B-05 Santa Ana, CA 92703
<br />$ 410.34
<br />Angie Y. Cruz, Oscar J. Ibarra
<br />1500 N. Harbor Blvd. #C-10 Santa Ana, CA 92703
<br />$ 1,679.00
<br />a .Mmir..lawnE . W.,Ram„ =s—W.1-
<br />1500 N. Harbor Blvd. #C-12 Santa Ana, CA 92703
<br />$ 6,250.00
<br />Gabriel E. Leal, Lauren J. Moss
<br />1500 N. Harbor Blvd. #D-02 Santa Ana, CA 92703
<br />$ 3,050,00
<br />Alexis Ocampo, Jessica Rojas
<br />1500 N. Harbor Blvd. #H-12 Santa Ana, CA 92703
<br />$ 350.50
<br />Nancy Reyes Tellez
<br />1500 N. Harbor Blvd. #K-05 Santa Ana, CA 92703
<br />$ 154.00
<br />Daisy D. Delgaldo, Jessica Delgaldo
<br />1500 N. Harbor Blvd. #K-06 Santa Ana, CA 92703
<br />$ 558.50
<br />Gabriella Nieblas, Leslie Rodriguez
<br />1500 N. Harbor Blvd. #M-04 Santa Ana, CA 92703
<br />$4,877.4_9
<br />Pablo Gonzalez, aeaticr Pano, Laloeth Sanchez
<br />1500 N. Harbor Blvd. #M-11 Santa Ana, CA 92703
<br />$ 1,176.99
<br />Rodrigo Conceives, Emanuella Muller
<br />1500 N. Harbor Blvd.,#M-12 Santa Ana, CA 92703
<br />$ 1,884.08
<br />$
<br />Total Amount of Assistance
<br />Requested
<br />$32,058.40
<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
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