LOCAL GOVERNMENT VERIFICATION OF CONTRIBUTION - GRANT FORM - CLEARWATER GARDENS - 1250 CLEVELAND ST - SHIP FLORIDA HOUSING FINANCE CORPORATION
LOCAL GOVERNMENT VERIFICATION OF CONTRIBUTION—GRANT FORM
Name of Development: Clearwater Gardens
Development Location: 1250 Cleveland Street,Clearwater
(Ata minimum,provide the address number,street name and city,and/or provide the street name,closest designated intersection 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)
The City/County of City of Clearwater commits$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 funds 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 must be effective as of the Application Deadline for the applicable RFA,and is
provided specifically with respect to the proposed Development.
SHIP
The source of the grant is:
(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'i -e e applicable RFA.
Micah Maxwell
Sim... - Print or Type Name
Interim City Manager
Print or Type Title
NOTE TO LOCAL GOVERNMENT OFFICIAL:Additional information is set forth in the applicable Request for Application
under which the Applicant is applying for funding for the above referenced Development.
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,maximum 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.07-2019)