Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Title Signature Date X form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS This certification is required by the regulations implementing Executive Order 12549, Debarment and suspension, 29 CFR Part 98.510, Participants’ responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211) (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION)
Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Title Signature Date X form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 EXHIBIT 3 INSTRUCTIONS FOR COMPLETION OF SF-LLL DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress. or an employee of a Member of Congress in connection with a covered Federal action. Use the SF LLL-A Continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Xxxxx Xxxxxx Signature Title Mayor Date 3/18/2018 X form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 EXHIBIT 3 INSTRUCTIONS FOR COMPLETION OF SF-LLL DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress. or an employee of a Member of Congress in connection with a covered Federal action. Use the SF LLL-A Continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include the street address, city, county, State, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Title Xxxxxxx X'Xxxxxxx Executive Director Signature Date X 3/21/2022 form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS This certification is required by the regulations implementing Executive Order 12549, Debarment and suspension, 29 CFR Part 98.510, Participants’ responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211) (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION)
Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include the street address, city, county, State, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Xxxxxx X. Xxxxxx Signature Title City Administrator Date 3/8/2018 X form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 EXHIBIT 3 INSTRUCTIONS FOR COMPLETION OF SF-LLL DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress. or an employee of a Member of Congress in connection with a covered Federal action. Use the SF LLL-A Continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Signature X Xxxxx Xxxx Title Associate Director Date 4/2/2019 form HUD-50070 (3/98) ref. Handbooks 7417.1 , 7475.13, 7485.1 & .3 DocuSign Envelope ID: 4AE69EF4-176F-453C-820B-E148B2708041 SERVICE XXXXXXXX XXXXX XxxxXxxxxxxxxxxxx 0X Xx Xxxxx Xxxx Xxxxxxxxx Placentia Xxxxx Xxxxx Buena Park La Palma Cypress Los Alamitos Xxxxxxx Anaheim Garden Grove Orange Villa Park Unincorporated Seal Beach Westminster Santa Xxx Xxxxxx Fountain Valley Cities of North Region ANAHEIM BREA BUENA PARK CYPRESS FULLERTON LA HABRA Huntington Beach Costa Mesa Newport Beach Irvine Laguna Xxxxx Lake Forest Rancho Santa Xxxxxxxxx Mission Viejo LA PALMA LOS ALAMITOS ORANGE PLACENTIA ROSSMOOR CDP XXXXXXX XXXXX PARK XXXXX XXXXX Region Cities of Central Region COSTA MESA FOUNTAIN VALLEY GARDEN GROVE HUNTINGTON BEACH MIDWAY CITY CDP NEWPORT BEACH NORTH TUSTIN CDP SANTA XXX XXXX BEACH TUSTIN WESTMINSTER Cities of South Region ALISO VIEJO COTO DE CAZA CDP XXXX POINT IRVINE LADERA RANCH CDP LAGUNA BEACH LAGUNA HILLS LAGUNA NIGUEL LAGUNA XXXXX LAKE FOREST LAS XXXXXX CDP Laguna Hills Aliso Viejo Laguna Beach Laguna Niguel San Xxxx Xxxxxxxxxx Xxxx Point San Clemente North Region Central Region South Region MISSION VIEJO RANCHO SANTA XXXXXXXXX SAN XXXXXXXX SAN XXXX CAPISTRANO
Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Title Signature Date X
Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include the street address, city, county, State, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U .S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Title Signature Date X Exhibit 3 INSTRUCTIONS FOR COMPLETION OF SF-LLL DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress. or an employee of a Member of Congress in connection with a covered Federal action. Use the SF LLL-A Continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the perfonnance of work done in coMection with the HUD funding of the program/activity shown above: Place of Perfonnance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. I�entify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here O, there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the infonnation stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. !001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Title Signature X Date form HUD-50070 (3/98) ref, Handbooks 7417.1, 7475,13, 7485.I & .3 Exhibit 5 Declaration of Restrictive Covenant RECORDED AT REQUEST OF, AND RETURN TO: Housing and Community Development and Homeless Services 0000 X. Xxxxx Xxx., Xxxx. X, 0xx Xxxxx Xxxxx Xxx, XX 00000-0000 Attention: Program Manager (Space above this linefor Recorder's use only.) DECLARATION OF RESTRICTIVE COVENANT (Homeless Shelter) (City of Buena Park) This Declaration of Restrictive Covenants ("Covenant") is made as of this day of ----� 2019, by the City of Buena Park, a California municipal corporation ("Owner") and the County of Orange, a political subdivision of the state of California, ("County"), with reference to the following facts:
Sites for Work Performance. The Applicant shall list (on separate pages) the site(s) for the performance of work done in connection with the HUD funding of the program/activity shown above: Place of Performance shall include xxx xxxxxx xxxxxxx, xxxx, xxxxxx, Xxxxx, and zip code. Identify each sheet with the Applicant name and address and the program/activity receiving grant funding.) Check here 0if there are workplaces on file that are not identified on the attached sheets. I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Name of Authorized Official Title ture Xxxx Xxxxxxxx Presidenk & CEO Signa Date 9/14/2018 X
