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CITY OF SANTA ANA HPRP FUNDING APPLICATION <br />Name of Organization: OC Partnership <br />Address: Mailing Address: 139 South Olive Street, Orange, CA 92866 <br />Phone: 714-288-4007 Fax: 714-288-1553 <br />Contact Person/Title: Dawn Lee <br />E-Mail Address: dawn.lee(a~ocpartnership.net <br />Tax Identification Number: 330831497 DUNS #: 14692973 (Required) <br />Year Organization Was Incorporated: 1998 <br />Proposed Program Title: Orange County Client Management Information System (CMIS) <br />Submit separate application if applying for more than one HPRP-eligible program <br />^ Homelessness Prevention ®Data Collection <br />This request is for: <br />(Check 1 only) ^ Rapid Rehousing <br />Amount of funding Requested: $50,000 <br />CERTIFYING REPRESENTATIVE (Person authorized to sign contract, if approved): The undersigned applicant certifies <br />that the information in this proposal is true and correct and the governing body of the applicant has duly <br />authorized the document. The applicant certifies that to the best of its knowledge and belief, neither it, nor any <br />person of which has an interest in the applicant's organization, nor any of the applicant's subcontractors, is <br />ineligible to: 1) be awarded contracts by any agency of the United States government or HUD; or, 2) participate in <br />HUD programs pursuant to 24 CFR Part 24. This certification is a material representation of fact upon which <br />reliance is placed when making award. If it is later determined that the applicant knowingly rendered an erroneous <br />certification, the contract may be terminated for default, and the applicant may be debarred or suspended from <br />participation in HUD and other federal programs administered by the City of Santa Ana. Additionally, the applicant <br />certifies that it has read, understands, and agrees to comply with all federal regulations, including but not limited <br />to 24 CFR Part 576 and Docket No. FR-5307-N-01) "Notice of Allocations, Application Procedures, and <br />Requirements for Homelessness Prevention and Rapid Re-Housing Program Grantees under the American <br />Recovery and Reinvestment Act of 2009." <br />Name: Dawn Lee ~_Y~""`~w <br />(Please Print or Type) <br />Title: Executive Director <br />Signature• <br />(Signature - in blue ink please) <br />Date Signed: ~~~ V I <br />RFP HOMELESSNESS PREVENTION & RAPID RE-HOUSING SERVICES 6/11/09 <br />2 <br />