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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. lnsutTiclent 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. 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: The imperial Apartments <br />Property Address: 1722 N. bush St. Santa Ana, CA. 92706 <br />Tax I® for Payment: 45-6756572 <br />Full Name of Tenant <br />(as stated on the <br />Lease) <br />Address of Tenant's Rental Unit <br />Total Amount <br />of Rent Arrears <br />®weed <br />Clrims Jorge Castelan <br />1722 N. Bush St. #102 Santa Ana, CA. 92704 <br />$ 6,620,00 <br />Robert Morales <br />1722 N. Bush St. #215 Santa Ana, CA. 92704 <br />$ 2,047.00 <br />Antonio Rafael Garcia <br />1722 N. Bush St. #301 Santa Ana, CA. 92704 <br />$ 4,991.00 <br />Elvira Grajeda Suarez <br />1722 N. Bush St. #309 Santa Ana, CA. 92704 <br />$ 4,862.00 <br />John Rico <br />1722 N. Bush St. #311 Santa Ana, CA. 92704 <br />$ t 3,872.00 <br />Estefany Martinez <br />1722 N. Bush St. 9312 Santa Ana, CA. 92704 <br />$ 4,923.00 <br />Jessica Leung <br />1722 N. Bush St. #401 Santa Ana, CA. 92704 <br />$ 3,452.00 <br />$ <br />$ <br />$ <br />$ <br />Total Amount of Assistance <br />Requested <br />$ 39,757.00 <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 />