LOCAL GOVERNMENT VERIFICATION OF CONTRIBUTION - GRANT FORMLOCAL GOVERNMENT VERIFICATION OF CONTRIBUTION — GRANT FORM
Name of Development: Chestnut Trail
645 Chestnut Street
Development Location: Clearwater, FL 33756
(At a minimum provide the address number, street name and city, and/or provide the street name, closest designated in tersection and either the
city (if located within a city) or county (if located in the unincorporated area of the county)_ If the Development consists of Scattered Sites, the
Development Location stated above must reflect the Scattered Site where the Development Location Point is located.)
On or before the Application Deadline. the CitylCounty of Clearwater committed
(Name of City or County)
$ 75,000.00 as a grant to the Applicant for its use solely for assisting the proposed Development
referenced above. The City /County does not expect to be repaid or reimbursed by the Applicant. or any other entity,
provided the fluids are expended solely for the Development referenced above. No consideration or promise of
consideration has been given with respect to the grant. For purposes of the foregoing, the promise of providing
affordable housing does not constitute consideration. The commitment for this grant is effective as of the
Application Deadline referenced above, and is provided specifically with respect to the proposed Development.
The source of the grant is: General Fund Reserves
(e_g., SHIP, HOME, CDBG)
CERTIFICATION
I certify that the foregoing information is true and correct and that this commitment is effective at least through the
date required in the applicable RFA.
Signature
Wiliam B. Home. II
Print or Type Name
City Manager
Print or Type Title
This certification must be signed by the chief appointed official (staff) responsible for such approvals, Mayor, City Manager.
County Manager /Administrator /Coordinator. Chairperson of the City Council /Commission or Chairperson of the Board of
County Commissioners. If the contribution is from a Land Authority organized pursuant to Chapter 380.0663, Florida Statutes,
this certification must be signed by the Chair of the Land Authority. One of the authorized persons named above may sign this
form for certification of state, federal or Local Government funds initially obtained by or derived from a Local Government that
is directly administered by an intermediary such as a housing finance authority, a community reinvestment corporation, or a state-
certified Community Housing Development Organization (CHDO). Other signatories are not acceptable. The Applicant will not
receive credit for this contribution if the certification is improperly signed. To be considered for points, the amount of the
contribution stated on this form must be a precise dollar amount and cannot include words such as estimated, up to, rnaxiruum of
not to exceed, etc.
If the Application is not eligible for automatic points. this contribution will not be considered if the certification contains
corrections or 'white-out' or if the certification is altered or retyped. The certification may be photocopied.
Please note: This form may be modified by Florida Housing Finance Corporation per Section 67- 60.005, F.A.C.
(Form Rev_ 01 -14)
RFA 2015 -107