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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 soreadsheet 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 />Cherry Creek Apartments <br />2701 S. Fairview Santa Ana, CA 92704 <br />85-1515234 <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 />Magaly Guzman, Alejandro Garcia <br />2701 S. Fairview #A-05 Santa Ana, CA 92704 <br />$ 275.50 <br />Bertie M. Oliver <br />2701 S. Fairview #A-07 Santa Ana, CA 92704 <br />$ 2,650.00 <br />Lucio Canalizo, Miverva Canalizo <br />2701 S. Fairview #B-02 Santa Ana, CA 92704 <br />$ 1,540.00 <br />Silvino Uribe, Aida Rivera <br />2701 S. Fairview #F-05 Santa Ana, CA 92704 <br />$ 1,871.67 <br />Abel Madrid, Claudia Urguiza <br />2701 S. Fairview W-06 Santa Ana, CA 92704 <br />$ 1,541.67 <br />Neri Gonzalez, Deisy Nolasco, Steven Lann <br />2701 S. Fairview #N-06 Santa Ana, CA 92704 <br />$ 1,145.00 <br />Fabiola Santos, Yara A. Aguilar <br />2701 S. Fairview #P-06 Santa Ana, CA 92704 <br />$ 863.49 <br />Miguel Santillian, Modesta Almazan <br />2701 S. Fairview #R-05 Santa Ana, CA 92704 <br />$ 457.50 <br />Total Amount of Assistance <br />Requested <br />$1 0 344.83 <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 />