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HomeMy WebLinkAboutContract 50852-A1 ✓� CITY SECRETARY �EG�\v2O CONTRACT NO.. saN 9 waR FIRST AMENDMENT TO CITY SECRETARY CONTRACT NO. 50852 WHEREAS, on June 26, 2018, the City of Fort Worth ("City") and Riverside Senior Investments, LP ("Developer") made and entered into City Secretary Contract No. 50852 (the "Contract")as authorized by M&C C-28409,adopted by the City Council on September 26,2017; WHEREAS,the funding provided to Developer in the Contract was from a grant received by City from the United States Department of Housing and Urban Development("HUD")through the HOME Investment Partnerships Program,Catalog of Federal Domestic Assistance No. 14.239; WHEREAS,the purpose of the Contract was to provide$1,100,000.00 in HOME funds in the form of a subordinate loan for a portion of the costs to develop the Sphinx at Sierra Vista Senior Villas, a 272-unit affordable housing development for seniors age 55 years and older; WHEREAS,Developer closed on the purchase of the land for the project on June 27,2018 using a portion of the HOME funds; WHEREAS, Developer applied for and was awarded a Multifamily Direct Loan from the Texas Department of Housing and Community Affairs for the project, and Developer has requested that City subordinate its loan to the Multifamily Direct Loan; WHEREAS,AHP Housing Fund 204,LLC has replaced Hunt Capital Partners,LLC as the Investor, and has requested certain changes to the Contract to reflect its interest as Developer's Investor Limited Partner as more particularly described in Developer's Amended and Restated Agreement of Limited Partnership; WHEREAS, Exhibit "B"—Budget must be amended to show the final loan amounts, tax credit proceeds and developer fee, and Exhibit "C" — Construction and Reimbursement Schedule must be amended to reflect the current timeline for project completion; WHEREAS,the Parties also desire to amend other Contract terms and provisions for clarity and to reflect current changes in applicable laws and regulations; and WHEREAS, it is the mutual desire of the City and Developer to amend the Contract to meet Contract objectives. NOW, THEREFORE, City and Developer hereby agree as follows: OFFICIAL RECORD CITY SECRETARY FT. WORTH,TX HOME DEVELOPER RENTAL CONTRACT CSC NO.50852—Al Sphinx at Sierra Vista Senior Villas Rev.06/17/2019 I. Section 2. DEFINITIONS is amended to be and read as follows by deleting the original of the definitions shown below and substituting the following: "Completion Deadline means March 31, 2021. "Conversion means the earlier of(i) the date the project's construction financing converts to permanent financing and begins principal amortization, or (ii) September 30, 2021. "Fort Worth Housing Finance Corporation or FWHFC means the Fort Worth Housing Finance Corporation, a Texas housing finance corporation and public instrumentality of the City, the sole member of Developer's General Partner, and the owner of the Property leased to Developer under the terms of a long term ground lease. "Ground Lease" means the lease agreement for the Property by and between FWHFC as Landlord and Developer as Tenant for a term of 99 years as evidenced by a recorded Memorandum of Ground Lease, as the same may be extended, amended, restated, modified, substituted, and renewed from time to time. "Investor means AHP Housing Fund 204, LLC, the entity purchasing the tax credits and Developer's Investor Limited Partner, or any of its successors and assigns. "Permanent Supportive Housing Tenant or PSH Tenant means a tenant of the PSH Units. "Subordination Agreements means the various subordination agreements by and among Developer's construction and permanent financing lenders, including the lenders of the first lien construction/permanent loans, TDHCA, Developer and City outlining the relative priorities of the construction and permanent loans, the MDL and the City's Loan for the project." Section 2. DEFINITIONS is amended to be and read as follows by adding the definitions shown below: "Multifamily Direct Loan or MDL means the subordinate loan to Developer by TDHCA. "MDL Loan Documents means any documents evidencing, securing or guaranteeing the Multifamily Direct Loan as the same may from time to time be extended, amended, restated, supplemented or otherwise modified." "Partnership Agreement means Developer's Amended and Restated Agreement of Limited Partnership which will admit Investor Limited Partner, as may be restated and/or amended from time to time. lI. HOME DEVELOPER RENTAL CONTRACT CSC NO. 50852—Al Page 2 Sphinx at Sierra Vista Senior Villas Rev. 06/17/2019 Section 5.6.1 Loan Terms and Conditions is amended as follows: Subsection 5.6.1.1 is amended to be and read as follows: "5.6.1.1 Execute and deliver the Deed Restriction, the Promissory Note and Deed of Trust along with any other Loan Documents required by City. Execute and deliver a Leasehold Deed of Trust to be substituted for the fee Deed of Trust after the Ground Lease has been executed. Subsection 5.6.1.5 is amended to be and read as follows: "5.6.1.5 Ensure that the Loan is subordinate only to the project's first lien construction/permanent financing and the Multifamily Direct Loan, each of which will be further described in their respective Subordination Agreements. City must approve in writing any secured financing for the project that will be subordinate to the Loan." Subsection 5.6.1.7 is amended to be and read as follows: "5.6.1.7 Simple interest on the Loan shall accrue at 1%per annum during the construction period. Beginning on the date of Conversion, simple interest shall accrue on the Loan at the lesser of the Long Term Applicable Federal Rate or 1% per annum. Interest shall accrue only from the date funds are advanced. Principal and accrued .interest shall be due and payable in equal annual installments based on a 35 year amortization schedule beginning 12 months after Conversion and continuing annually thereafter on the anniversary date of the first payment until the Final Payment Date in the Promissory Note, which shall be the maturity date of Developer's first lien permanent loan. Payments of principal and interest are only payable from Net Cash Flow as defined in Developer's Partnership Agreement. Principal and interest to the extent not paid from Net Cash Flow shall be paid from subsequent year's Net Cash Flow until the Final Payment Date when the entire unpaid principal and accrued interest will be due in full. Payments will be applied first to accrued interest and the remainder to reduction of principal. HOME DEVELOPER RENTAL CONTRACT CSC NO. 50852—Al Page 3 Sphinx at Sierra Vista Senior Villas Rev.06/17/2019 Subsection 5.6.1.10 is amended to be and read as follows: "5.6.1.10 Except for permanent loan conversion with Developer's permanent lender,refinancing by Developer or any subordinate financing for the project, other than the MDL, shall require the review and prior written approval of City for the purpose of ensuring compliance with the HOME underwriting and subsidy layering requirements, which approval shall not be unreasonably withheld, conditioned or delayed. City hereby specifically approves the MDL." Section 7 TENANT AND LEASE REQUIREMENTS; PROPERTY STANDARDS DURING AFFORDABILITY PERIOD is amended by adding new Section 7.10 and new Section 7.11: "7.10 Violence Against Women Act Requirements 7.10.1 As applicable, Developer shall comply with the Violence Against Women Act ("VAWA") and shall ensure that its property manager shall, at the time of application for a unit in the project, provide all potential tenants receiving rental assistance with a Notice of Occupancy Rights under the Violence Against Women Act in substantially the same form as the form attached and incorporated as Exhibit "N" — VAWA Forms in compliance with VAWA and 24 CFR Part 92.359 of the HOME Regulations. 7.10.2 Developer agrees that no applicant for a unit in the project may be denied on the basis or as a direct result of the fact that they are or have been a victim of domestic violence, dating violence, sexual assault, or stalking, as long as they would otherwise qualify for the unit. 7.10.3 Developer shall be responsible for reviewing VAWA and any applicable regulations and shall respond to all emergency transfer requests in accordance with the requirements of those provisions. Developer may request that all tenants requesting an emergency transfer under VAWA fill out the form attached and incorporated in Exhibit "N" —VAWA Forms or its own form that is substantially the same." "7.11 PSH Program, Units and Tenants. Developer acknowledges that it obtained a Resolution of No Objection from the City Council for its application to TDHCA for the Housing Tax Credits by committing to provide 14 PSH Units in the project for the City's PSH Program. FWHFC has agreed to pay for the Supportive Services Provider for the PSH Tenants. Developer is responsible for obtaining project-based vouchers, tenant based rental assistance or other rental assistance to subsidize the rents for the PSH Units and will enter into separate agreements with the entities furnishing the vouchers and/or the rental assistance. The PSH Program for the project will be managed in accordance with the requirements of Exhibit "M" — Requirements for Permanent Supportive Housing Units. HOME DEVELOPER RENTAL CONTRACT CSC NO. 50852—Al Page 4 Sphinx at Sierra Vista Senior Villas Rev. 06/17/2019 7.11.1 Developer agrees to make all reasonable good faith efforts to obtain vouchers or rental assistance for the PSH Tenants. However, if Developer is unable to do so,after documenting to City in writing such reasonable good faith efforts,Developer shall request in writing that City allow the number of PSH Units to be reduced and allow such units to be rented to a tenant who is not a PSH Tenant. If City, in its reasonable discretion, determines that Developer has made all reasonable good faith efforts to obtain voucher or rental assistance but has been unable to do so, then Developer and City will enter into a written amendment to this Contract documenting the number of remaining PSH Units and whether such reduction in the number of PSH Units shall be permanent or temporary, as well as other conditions relevant to the PSH Program including but not limited to revising the homeless subpopulation to be served. 7.11.2 Developer agrees to furnish City with final,executed copies of any contracts it has with agencies or third parties for vouchers or other forms of rental assistance for the PSH Tenants. 7.11.3 Termination of PSH Requirement. 7.11.3.1 City may, with 180 days' written notice to Developer, end the PSH Program for the project if it determines, in its sole discretion,that the PSH Program for the project is no longer financially viable or does not meet the City's goals of reducing chronic homelessness. In that event, Developer's obligation to provide the PSH Units shall cease. During that 180-day period, City, FWHFC and Developer shall coordinate with agencies providing supportive services, vouchers or rental assistance so that no PSH Tenant will be displaced. Notwithstanding the forgoing, City and Developer acknowledge and agree that City's termination of the PSH Program under this subsection shall in no way limit or interfere with any other contractual duty of Developer in this Contract or contained in any other agreement with an agency or other third party for vouchers or rental assistance for the PSH Units. 7.11.3.2 In the event the City releases Developer from its obligation to provide the PSH Units,FWHFC will cease paying for the supportive services. FWHFC will give Developer 180 days' written notice of its termination of payment for the supportive services for the PSH Tenants." Section 11.1 Failure to Begin or Complete the Required Improvements is amended as follows: Subsection 11.1.1 is amended to be and read as follows: HOME DEVELOPER RENTAL CONTRACT CSC NO. 50852—Al Page 5 Sphinx at Sierra Vista Senior Villas Rev. 06/17/2019 "11.1.1 If Developer fails to begin construction within 90 days of the closing of the construction loan for the project, this Contract shall automatically terminate without further warning or opportunity to cure, and with no penalty or liability to City." Section 14.10 Compliance With All Applicable Laws and Regulations is amended by adding the following: ➢ Violence Against Women Act of 1994, 42 U.S.C. 13981" Section 21 NOTICE is amended by deleting the "City" and "Investor" contacts and replacing them with the following: "City: City Attorney's Office 200 Texas Street Fort Worth, TX 76102 Attention: Vicki Ganske or Jo Pate Telephone: 817-392-7600 "Copy to: Neighborhood Services Department 200 Texas Street Fort Worth, TX 76102 Attention: Chad LaRoque Telephone: 817-392-2661 "Investor: AHP Housing Fund 204, LLC 10250 Constellation Boulevard, Suite 3000 Los Angeles, California 90067 Attention: Michael L. Fowler "Copy to: Kutak Rock LLP 1801 California Street, Suite 3000 Denver, Colorado 80202-5596 Attention: Ellen K. O'Brien Telephone: 303-292-7810" III. Exhibit "B"—Budget attached to the Contract is hereby replaced with the attached Exhibit "B"—Budget Revised 06/2019. HOME DEVELOPER RENTAL CONTRACT CSC NO. 50852—Al Page 6 Sphinx at Sierra Vista Senior Villas Rev. 06/17/2019 Exhibit "C"—Construction And Reimbursement Schedule attached to the Contract is hereby replaced with the attached Exhibit"C" —Construction And Reimbursement Schedule Revised 06/2019. Exhibit "M"—Requirements for Permanent Supportive Housing Units is hereby replaced with the attached Exhibit "M" —Requirements for Permanent Supportive Housing Units Revised 06/2019. Exhibit "N"—VAWA Forms attached hereto is added to the Contract. The list of EXHIBITS attached to the Contract is deleted and replaced with the attached list of EXHIBITS REVISED 06/2019. IV. This amendment is effective as of the Effective Date of the Contract. V. All terms and conditions of the Contract not amended herein remain unaffected and in full force and effect, are binding on the Parties and are hereby ratified by the Parties. Capitalized terms not defined herein shall have the meanings assigned to them in the Contract. [SIGNATURES APPEAR ON NEXT PAGE] HOME DEVELOPER RENTAL CONTRACT CSC NO. 50852—A 1 Page 7 Sphinx at Sierra Vista Senior Villas Rev. 06/17/2019 F�RTb .WITNESS WHEREOF, the Parties have executed 4 duplicate originals of this Contract to ective as of the Effective Date. a7 T: CITY OF FORT WORTH By: City secret Fernando Costa, Assistant City Manager �E7C C M&C C-28409 Dated Sept. 26, 2017 Date: roA�9 Form 1295: 2017-252011 APPR VED AS T(O' FO AND LEGALITY: Vicki Ganske, Senior Assistant City Attorney CONTRACT COMPLIANCE MANAGER: By signing, I acknowledge that I am the person responsible for the monitoring and administration of this Contract, including ensuring all performance and reporting requirements. Chad LaRoque, Housing Development and Grants Manager RIVERSIDE SENIOR INVESTMENTS,LP a Texas limited partnership, By: Riverside Senior Development GP, LLC a Texas limited liability company, its general partner By: Fort Worth Housing Finance Corporation, a Texas housing finance corporation, its sole member By. Fernando Costa, General Manager Date: OFFICIAL RECORD CITY SECRETARY HOME DEVELOPER RENTAL CONTRACT CSC NO. 50852—Al FT WORTH,TX Sphinx at Sierra Vista Senior Villas. SlgndUlre rage EXHIBITS REVISED 06/2019: Exhibit "A" —Project Summary Exhibit "A-1"—HUD Rent Limits Exhibit "A-2"—Environmental Mitigation Action Exhibit "B" —Budget Exhibit "C" —Construction and Reimbursement Schedule Exhibit "D" —Audit Requirements—Not Applicable Exhibit "E"—Loan Documents Exhibit "F" —Reimbursement Forms Exhibit "G" —Project Compliance Report: Rental Housing Exhibit "H"—Federal Labor Standards Provisions—Davis-Bacon Requirements Exhibit "I" —Section 3 Reporting Forms Exhibit "J" —Standards for Complete Documentation Exhibit "K"—Contract and Subcontract Activity Reporting Form Exhibit "L"—Deed Restriction Exhibit "M" —Requirements for Permanent Supportive Housing Units Exhibit"N" —VAWA Forms HOME DEVELOPER RENTAL CONTRACT CSC NO. 50852—Al Rev.06/17/19 Sphinx at Sierra Vista Senior Villas. List of Exhibits Page EXHIBIT "B" BUDGET REVISED 06/2019 SPHINX AT SIERRA VISTA SENIOR VILLAS SOURCES Construction Loan Stage Permanent Loan Financing Source# Funding Description Lien Priority Amount Stage Amount Participants Tax Exempt Bonds Tarrant County issued by Tarrant Housing County Housing Finance 1 Finance Corporation 1 st $23,000,000 $19,125,000 Corporation Conventional Taxable 2 Loan 1st $5,350,000 Citibank,N.A. Housing Tax Credit AHP Housing 3 Syndication Proceeds $7,242,013 $14,887,054 Fund 204,LLC Texas Department of Housing and Community 4 Multifamily Direct Loan 2nd $3,600,000 $3,600,000 Affairs City of Fort 5 HOME Loan 3rd $1,100,000 $1,100,000 Worth Tarrant County Housing Finance 6 Tax Exempt Bonds Corporation NEZ Incentive Fee City of Fort 7 Waivers $180,000 $180,000 Worth Sphinx In-Kind Equity/Deferred Development 8 Developer Fee $3,769,558 Corporation TOTAL SOURCES OF FUNDS++ $42,661,612 TOTAL USES OF FUNDS++ $42,661,612 ++See next page for detail. Summary HOME Funds Budget++ Land Acquisition $1,045,000* Construction Hard Costs $5,000* Holdback** $50,000* TOTAL $1,100,000 *Developer will only be reimbursed for eligible expenses. The amounts are estimates and are subject to change. ** City will hold back$50,000.00 of the HOME Funds until City verifies that the first HOME Unit is leased to a HOME Eligible Household as well as the other requirements in Exhibit"C"-Construction and Reimbursement Schedule. HOME DEVELOPER RENTAL CONTRACT EXHIBITS—CSC NO. 50852—Al Rev.06/17/2019 Sphinx at Sierra Vista Senior Villas Page 1 ►•a r 1�0 � •�-� 0000 �Q Q DD \O v') vi 00 — \,Z N 00 O 64 64 l tn 00 00 00 Z O t a S on 69 W a U cn A O A A y O O O � L w x o O 00 p � > •� o0 00 00 c� F 3 ds Gn Ge C NN oa v� c o 0 0 0 a c x a o CDo a a H w M o 6A ., s m °�° C) 00 110 00 v N4GoS 69 69 COS e E., x ' o 0 0 .� `z rW� Cp�Jr z a v O O b N OroCD N 00 Ci Q 69 69 k cr !t N 69 9 6 69 69 69 C. 0000 A aw 00 z A dw x � a` A z U U � Z � N oN Cl ern o o C I Q L N � 00 M Mtj 0-0 W In m � Q exd O O 4GoS 666 6601 x V z (~ V V � W z ONO O O O U �O N O O aQ W Z x r-I - � N O p U W C tr 00 FA ri M z QOrs, x o 4GoS F» r4 O x o � cd '� o `5 4-� O ice+ O L d �, A V z Q � •o °� ° U d � � d o W w z a z W > F" F, r1 a w A a .-�1 U iw Q E- U i W e H x rn EXHIBIT "C" CONSTRUCTION AND REIMBURSEMENT SCHEDULE REVISED 06/2019 SPHINX AT SIERRA VISTA SENIOR VILLAS Activity HOME Funds PHASE I ACTIVITIES: Land Acquisition $1,045,000.00* Predevelopment Soft Costs PHASE I COMPLETE by: First Payment** $1,045,000.00* June 29,2018 PHASE II ACTIVIITES: Construction Hard Costs $2,500.00 Prior to Reimbursement in Phase II, Developer must PHASE II submit the contractor/subcontractor/vendor searches COMPLETE by: under the Federal System for Award Management December 31,2019 (www.sam.gov). Second Payment** (approx. 25% complete)*** PHASE III ACTIVIITES: Construction Hard Costs $2,500.00 Prior to Reimbursement in Phase III, Developer must PHASE III submit the contractor/subcontractor/vendor searches COMPLETED by: under the Federal System for Award Management December 31, 2020 (www.sam.gov). Third Payment** (approx. 75% complete)*** PHASE IV ACTIVITIES: Initial Lease-up of HOME Units $50,000.00 PHASE IV Prior to Reimbursement in Phase IV, the following items COMPLETED by: must be submitted: March 31,2021 1. Rent Schedule for HOME Units. See Section 7.5 2. Tenant Selection Policy. See Section 7.6 3. Affirmative Marketing Plan. See Section 7.7 Prior to Reimbursement for Final Payment, Exhibit "G" - Project Compliance Report: Rental Housing must be submitted to City. Final Payment** (Lease-Up of HOME Unit)*** $50,000.00* TOTAL $1,100,000.00 *Developer will only be reimbursed for eligible expenses. The amounts are estimates and are subject to change. **Developer must submit Complete Documentation with Reimbursement Request to City within 60 days from each of the abovementioned deadlines in order to be reimbursed. Failure to timely submit Reimbursement Requests and Complete Documentation along with any required reports shall be an event of default. ***If milestone is reached before the Phase completion date, reimbursement will be made when the milestone percentage is reached and the City is provided all required documentation. HOME DEVELOPER RENTAL CONTRACT EXHIBITS—CSC NO. 50852—Al Rev. 06/17/2019 Sphinx at Sierra Vista Senior Villas Page 3 EXHIBIT "M" REQUIREMENTS FOR PERMANENT SUPPORTIVE HOUSING UNITS REVISED 05/19 SPHINX AT SIERRA VISTA SENIOR VILLAS The purpose of the PSH Units is to reduce the population of homeless persons in City homeless shelters. The goal of the City's PSH Program is to provide permanent, stable and supportive housing for homeless persons with disabilities in order to promote their self-sufficiency and foster their ability to live independently. 1. The FWHFC will retain the Supportive Services Provider for the PSH Tenants. The scope of the supportive services shall be determined by FWHFC but at a minimum shall include an on-site case manager with experience in providing case management to homeless and formerly homeless persons. The cost of the PSH Supportive Services Provider will be paid by FWHFC. 2. Developer's property manager for the project will communicate and coordinate as necessary with the Supportive Services Provider and with the providers of any rental assistance or rental vouchers to the PSH Tenants to ensure that the objectives of the PSH Program are met. 3. Developer will promptly notify City, FWHFC and the Supportive Services Provider in writing of the specific date when lease-up of the project will begin so that the Supportive Services Provider can initiate a referral and the coordination process for potential tenants for the PSH Units. 4. PSH Tenants must meet HUD's definition of chronically homeless, or be designated as having priority status by the Continuum of Care for TX-601 Fort Worth/Arlington/Tarrant County("CoC"),or meet some other reasonably equivalent standards of need for housing and supportive services due to the nature and extent of their disability and duration of their homeless status. PSH Tenants will be selected from the prioritized CoC permanent supportive housing list maintained by the Tarrant County Homeless Coalition. 5. Developer, at its expense, will provide dedicated and secured on-site office space to the Supportive Services Provider's staff member as well as a telephone line and internet access sufficient for the staff member to access HMIS, the Homeless Management Information System maintained by the CoC. The property manager shall coordinate with the designated staff member as necessary to fulfill the purposes of the PSH Program. 6. Property manager will coordinate with the Supportive Services Provider regarding selection and placement of PSH Tenants ensuring that tenant selection criteria for the PSH Units is appropriate and consistent with the purpose of the PSH Program as well as the property management practices for the project. Property Manager will not unreasonably deny housing to eligible homeless persons who otherwise meet the PSH Program's standards for services. 7. The property manager shall promptly notify the Supportive Services Provider in writing in any case of a PSH Tenant's financial hardship, lease violation, or any other circumstances deemed appropriate by Developer or property manager,to avoid involuntary termination of tenancies for the PSH Units. HOME DEVELOPER RENTAL CONTRACT EXHIBITS—CSC NO.50852—Al Rev.06/17/2019 Sphinx at Sierra Vista Senior Villas Page 4 EXHIBIT "N" VAWA FORMS SPHINX AT SIERRA VISTA SENIOR VILLAS Notice of Occupancy Rights under the Violence Against Women Act (Form HUD-5380) Model Emergency Transfer Plan for Victims of Domestic Violence, Dating Violence, Sexual Assault, or Stalking (Form HUD-5381) Emergency Transfer Request for Certain Victims of Domestic Violence, Dating Violence, Sexual Assault, or Stalking (Form HUD-5383) Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking and Alternate Documentation (Form HUD-5382) Violence, Dating Violence or Stalking Lease Addendum (Form HUD-91067) Where permitted by federal regulations, Developer may use its own forms so long as they meet the requirements of the VAWA and its accompanying regulations. Developer is responsible for ensuring that the proper forms and required actions are taken in compliance with VAWA and any applicable regulations, and acknowledges that it is solely responsible for using the appropriate forms as they may be changed from time to time. HOME DEVELOPER RENTAL CONTRACT EXHIBITS—CSC NO. 50852—Al Rev. 06/17/2019 Sphinx at Sierra Vista Senior Villas Page 5 NOTICE OF OCCUPANCY RIGHTS UNDER U.S. Department of Housing and Urban Development THE VIOLENCE AGAINST WOMEN ACT OMB Approval No.2577-0286 Expires 06/30/2017 Sphinx at Sierra Vista Senior Villas i Notice of Occupancy Rights under the Violence Against Women Act2 To all Tenants and Applicants The Violence Against Women Act(VAWA) provides protections for victims of domestic violence, dating violence, sexual assault, or stalking. VAWA protections are not only available to women, but are available equally to all individuals regardless of sex, gender identity, or sexual orientation.3 The U.S. Department of Housing and Urban Development (HUD) is the Federal agency that oversees that [insert name of program or rental assistance] is in compliance with VAWA. This notice explains your rights under VAWA. A HUD-approved certification form is attached to this notice. You can fill out this form to show that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking, and that you wish to use your rights under VAWA." Protections for Applicants If you otherwise qualify for assistance under [insert name of program or rental assistance], you cannot be denied admission or denied assistance because you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. Protections for Tenants ' The notice uses HP for housing provider but the housing provider should insert its name where HP is used. HUD's program-specific regulations identify the individual or entity responsible for providing the notice of occupancy rights. z Despite the name of this law,VAWA protection is available regardless of sex, gender identity,or sexual orientation. s Housing providers cannot discriminate on the basis of any protected characteristic, including race,color,national origin,religion, sex, familial status,disability, or age. HUD-assisted and HUD-insured housing must be made available to all otherwise eligible individuals regardless of actual or perceived sexual orientation,gender identity,or marital status. Form HUD-5380 (06/2017) 2 If you are receiving assistance under [,insert name of program or rental assistance],you may not be denied assistance, terminated from participation, or be evicted from your rental housing because you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. Also, if you or an affiliated individual of yours is or has been the victim of domestic violence, dating violence, sexual assault, or stalking by a member of your household or any guest, you may not be denied rental assistance or occupancy rights under [insert name of program or rental assistance] solely on the basis of criminal activity directly relating to that domestic violence, dating violence, sexual assault, or stalking. Affiliated individual means your spouse,parent, brother, sister, or child, or a person to whom you stand in the place of a parent or guardian (for example,the affiliated individual is in your care, custody, or control); or any individual,tenant, or lawful occupant living in your household. Removing the Abuser or Perpetrator from the Household HP may divide (bifurcate) your lease in order to evict the individual or terminate the assistance of the individual who has engaged in criminal activity (the abuser or perpetrator) directly relating to domestic violence, dating violence, sexual assault, or stalking. If HP chooses to remove the abuser or perpetrator, HP may not take away the rights of eligible tenants to the unit or otherwise punish the remaining tenants. If the evicted abuser or perpetrator was the sole tenant to have established eligibility for assistance under the program, HP must allow the tenant who is or has been a victim and other household members to remain in the unit for a period of time, in order to establish eligibility under the program or under another HUD housing program covered by VAWA, or, find alternative housing. Form HUD-5380 (06/2017) 3 In removing the abuser or perpetrator from the household, HP must follow Federal, State, and local eviction procedures. In order to divide a lease, HP may, but is not required to, ask you for documentation or certification of the incidences of domestic violence, dating violence, sexual assault, or stalking. Moving to Another Unit Upon your request, HP may permit you to move to another unit, subject to the availability of other units, and still keep your assistance. In order to approve a request, HP may ask you to provide documentation that you are requesting to move because of an incidence of domestic violence, dating violence, sexual assault, or stalking. If the request is a request for emergency transfer, the housing provider may ask you to submit a written request or fill out a form where you certify that you meet the criteria for an emergency transfer under VAWA. The criteria are: (1) You are a victim of domestic violence, dating violence, sexual assault, or stalking. If your housing provider does not already have documentation that you are a victim of domestic violence, dating violence, sexual assault, or stalking, your housing provider may ask you for such documentation, as described in the documentation section below. (2) You expressly request the emergency transfer. Your housing provider may choose to require that you submit a form, or may accept another written or oral request. (3) You reasonably believe you are threatened with imminent harm from further violence if you remain in your current unit. This means you have a reason to fear that if you do not receive a transfer you would suffer violence in the very near future. Form HUD-5380 (06/2017) 4 OR You are a victim of sexual assault and the assault occurred on the premises during the 90-calendar-day period before you request a transfer. If you are a victim of sexual assault, then in addition to qualifying for an emergency transfer because you reasonably believe you are threatened with imminent harm from further violence if you remain in your unit, you may qualify for an emergency transfer if the sexual assault occurred on the premises of the property from which you are seeking your transfer, and that assault happened within the 90-calendar-day period before you expressly request the transfer. HP will keep confidential requests for emergency transfers by victims of domestic violence, dating violence, sexual assault, or stalking, and the location of any move by such victims and their families. HP's emergency transfer plan provides further information on emergency transfers, and HP must make a copy of its emergency transfer plan available to you if you ask to see it. Documenting You Are or Have Been a Victim of Domestic Violence, Dating Violence, Sexual Assault or Stalking HP can, but is not required to, ask you to provide documentation to "certify" that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. Such request from HP must be in writing, and HP must give you at least 14 business days (Saturdays, Sundays, and Federal holidays do not count) from the day you receive the request to provide the documentation. HP may, but does not have to, extend the deadline for the submission of documentation upon your request. Form HUD-5380 (06/2017) 5 You can provide one of the following to HP as documentation. It is your choice which of the following to submit if HP asks you to provide documentation that you are or have been a victim of domestic violence, dating violence, sexual assault, or stalking. • A complete HUD-approved certification form given to you by HP with this notice, that documents an incident of domestic violence, dating violence, sexual assault, or stalking. The form will ask for your name, the date, time, and location of the incident of domestic violence, dating violence, sexual assault, or stalking, and a description of the incident. The certification form provides for including the name of the abuser or perpetrator if the name of the abuser or perpetrator is known and is safe to provide. • A record of a Federal, State, tribal, territorial, or local law enforcement agency, court, or administrative agency that documents the incident of domestic violence, dating violence, sexual assault, or stalking. Examples of such records include police reports, protective orders, and restraining orders, among others. • A statement, which you must sign, along with the signature of an employee, agent, or volunteer of a victim service provider, an attorney, a medical professional or a mental health professional (collectively, "professional") from whom you sought assistance in addressing domestic violence, dating violence, sexual assault, or stalking, or the effects of abuse, and with the professional selected by you attesting under penalty of perjury that he or she believes that the incident or incidents of domestic violence, dating violence, sexual assault, or stalking are grounds for protection. • Any other statement or evidence that HP has agreed to accept. If you fail or refuse to provide one of these documents within the 14 business days, HP does not have to provide you with the protections contained in this notice. Form HUD-5380 (06/2017) 6 If HP receives conflicting evidence that an incident of domestic violence, dating violence, sexual assault, or stalking has been committed (such as certification forms from two or more members of a household each claiming to be a victim and naming one or more of the other petitioning household members as the abuser or perpetrator), HP has the right to request that you provide third-party documentation within thirty 30 calendar days in order to resolve the conflict. If you fail or refuse to provide third-party documentation where there is conflicting evidence, HP does not have to provide you with the protections contained in this notice. Confidentiality HP must keep confidential any information you provide related to the exercise of your rights under VAWA, including the fact that you are exercising your rights under VAWA. HP must not allow any individual administering assistance or other services on behalf of HP (for example, employees and contractors) to have access to confidential information unless for reasons that specifically call for these individuals to have access to this information under applicable Federal, State, or local law. HP must not enter your information into any shared database or disclose your information to any other entity or individual. HP, however, may disclose the information provided i£ • You give written permission to HP to release the information on a time limited basis. • HP needs to use the information in an eviction or termination proceeding, such as to evict your abuser or perpetrator or terminate your abuser or perpetrator from assistance under this program. • A law requires HP or your landlord to release the information. Form HUD-5380 (06/2017) VAWA does not limit HP's duty to honor court orders about access to or control of the property. This includes orders issued to protect a victim and orders dividing property among household members in cases where a family breaks up. Reasons a Tenant Eligible for Occupancy Rights under VAWA May Be Evicted or Assistance May Be Terminated You can be evicted and your assistance can be terminated for serious or repeated lease violations that are not related to domestic violence, dating violence, sexual assault, or stalking committed against you. However, HP cannot hold tenants who have been victims of domestic violence, dating violence, sexual assault, or stalking to a more demanding set of rules than it applies to tenants who have not been victims of domestic violence, dating violence, sexual assault, or stalking. The protections described in this notice might not apply, and you could be evicted and your assistance terminated, if HP can demonstrate that not evicting you or terminating your assistance would present a real physical danger that: 1) Would occur within an immediate time frame, and 2) Could result in death or serious bodily harm to other tenants or those who work on the property. If HP can demonstrate the above, HP should only terminate your assistance or evict you if there are no other actions that could be taken to reduce or eliminate the threat. Other Laws VAWA does not replace any Federal, State, or local law that provides greater protection for victims of domestic violence, dating violence, sexual assault, or stalking. You may be entitled to Form HUD-5380 (06/2017) 8 additional housing protections for victims of domestic violence, dating violence, sexual assault, or stalking under other Federal laws, as well as under State and local laws. Non-Compliance with The Requirements of This Notice You may report a covered housing provider's violations of these rights and seek additional assistance, if needed, by contacting or filing a complaint with [insert contact information for any intermediary, if applicable] or [insert HUD field office]. For Additional Information You may view a copy of HUD's final VAWA rule at [insert Federal Register link]. Additionally, HP must make a copy of HUD's VAWA regulations available to you if you ask to see them. For questions regarding VAWA, please contact [insert name of program or rental assistance contact information able to answer questions on VAWA]. For help regarding an abusive relationship, you may call the National Domestic Violence Hotline at 1-800-799-7233 or, for persons with hearing impairments, 1-800-787-3224 (TTY). You may also contact [Insert contact information for relevant local organizations]. For tenants who are or have been victims of stalking seeking help may visit the National Center for Victims of Crime's Stalking Resource Center at https://www.victimsofcrime.org/our- programs/stalking-resource-center. For help regarding sexual assault, you may contact [Insert contact information for relevant organizations] Victims of stalking seeking help may contact [Insert contact information for relevant organizations]. Attachment: Certification form HUD-XXXXX [form approved for this program to be included] Form HUD-5380 (06/2017) MODEL EMERGENCY TRANSFER PLAN FOR U.S. Department of Housing and Urban Development VICTIMS OF DOMESTIC VIOLENCE,DATING OMB Approval No.2577-0286 VIOLECE, SEXUAL ASSAULT,OR STALKING Expires 06/30/20I7 Sphinx at Sierra Vista Senior Villas Model Emergency Transfer Plan for Victims of Domestic Violence, Dating Violence, Sexual Assault, or Stalking Emergency Transfers [Insert name of covered housing provider(acronym HP for purposes of this model plan)] is concerned about the safety of its tenants, and such concern extends to tenants who are victims of domestic violence, dating violence, sexual assault, or stalking. In accordance with the Violence Against Women Act (VAWA),1 HP allows tenants who are victims of domestic violence, dating violence, sexual assault, or stalking to request an emergency transfer from the tenant's current unit to another unit. The ability to request a transfer is available regardless of sex, gender identity, or sexual orientation.2 The ability of HP to honor such request for tenants currently receiving assistance,however, may depend upon a preliminary determination that the tenant is or has been a victim of domestic violence, dating violence, sexual assault, or stalking, and on whether HP has another dwelling unit that is available and is safe to offer the tenant for temporary or more permanent occupancy. This plan identifies tenants who are eligible for an emergency transfer, the documentation needed to request an emergency transfer, confidentiality protections, how an emergency transfer may occur, and guidance to tenants on safety and security. This plan is based on a model ' Despite the name of this law, VAWA protection is available to all victims of domestic violence, dating violence, sexual assault, and stalking,regardless of sex, gender identity, or sexual orientation. z Housing providers cannot discriminate on the basis of any protected characteristic,including race, color,national origin,religion, sex,familial status, disability, or age. HUD-assisted and HUD-insured housing must be made available to all otherwise eligible individuals regardless of actual or perceived sexual orientation,gender identity,or marital status. Form HUD-5381 (06/2017) 2 emergency transfer plan published by the U.S. Department of Housing and Urban Development (HUD), the Federal agency that oversees that [insert name of prolzram or rental assistance here] is in compliance with VAWA. Eligibility for Emergency Transfers A tenant who is a victim of domestic violence, dating violence, sexual assault, or stalking, as provided in HUD's regulations at 24 CFR part 5, subpart L is eligible for an emergency transfer, if: the tenant reasonably believes that there is a threat of imminent harm from further violence if the tenant remains within the same unit. If the tenant is a victim of sexual assault, the tenant may also be eligible to transfer if the sexual assault occurred on the premises within the 90-calendar- day period preceding a request for an emergency transfer. A tenant requesting an emergency transfer must expressly request the transfer in accordance with the procedures described in this plan. Tenants who are not in good standing may still request an emergency transfer if they meet the eligibility requirements in this section. Emergency Transfer Request Documentation To request an emergency transfer, the tenant shall notify HP's management office and submit a written request for a transfer to [HP to insert location]. HP will provide reasonable accommodations to this policy for individuals with disabilities. The tenant's written request for an emergency transfer should include either: 1. A statement expressing that the tenant reasonably believes that there is a threat of imminent harm from further violence if the tenant were to remain in the same dwelling unit assisted under HP's program; OR Form HUD-5381 (06/2017) 3 2. A statement that the tenant was a sexual assault victim and that the sexual assault occurred on the premises during the 90-calendar-day period preceding the tenant's request for an emergency transfer. Confidentiality HP will keep confidential any information that the tenant submits in requesting an emergency transfer, and information about the emergency transfer,unless the tenant gives HP written permission to release the information on a time limited basis, or disclosure of the information is required by law or required for use in an eviction proceeding or hearing regarding termination of assistance from the covered program. This includes keeping confidential the new location of the dwelling unit of the tenant, if one is provided, from the person(s)that committed an act(s) of domestic violence, dating violence, sexual assault, or stalking against the tenant. See the Notice of Occupancy Rights under the Violence Against Women Act For All Tenants for more information about HP's responsibility to maintain the confidentiality of information related to incidents of domestic violence, dating violence, sexual assault, or stalking. Emergency Transfer Timing and Availability HP cannot guarantee that a transfer request will be approved or how long it will take to process a transfer request. HP will, however, act as quickly as possible to move a tenant who is a victim of domestic violence, dating violence, sexual assault, or stalking to another unit, subject to availability and safety of a unit. If a tenant reasonably believes a proposed transfer would not be safe,the tenant may request a transfer to a different unit. If a unit is available,the transferred tenant must agree to abide by the terms and conditions that govern occupancy in the unit to which the tenant has been transferred. HP may be unable to transfer a tenant to a particular unit if the tenant has not or cannot establish eligibility for that unit. Form HUD-5381 (06/2017) 4 If HP has no safe and available units for which a tenant who needs an emergency is eligible, HP will assist the tenant in identifying other housing providers who may have safe and available units to which the tenant could move. At the tenant's request, HP will also assist tenants in contacting the local organizations offering assistance to victims of domestic violence, dating violence, sexual assault, or stalking that are attached to this plan. Safety and Security of Tenants Pending processing of the transfer and the actual transfer, if it is approved and occurs, the tenant is urged to take all reasonable precautions to be safe. Tenants who are or have been victims of domestic violence are encouraged to contact the National Domestic Violence Hotline at 1-800-799-7233, or a local domestic violence shelter, for assistance in creating a safety plan. For persons with hearing impairments,that hotline can be accessed by calling 1-800-787-3224 (TTY). Tenants who have been victims of sexual assault may call the Rape, Abuse & Incest National Network's National Sexual Assault Hotline at 800-656-HOPE, or visit the online hotline at https:Hohl.rainn.org/online/. Tenants who are or have been victims of stalking seeking help may visit the National Center for Victims of Crime's Stalking Resource Center at https://www.victimsofcrime.org/our- programs/stalking-resource-center. Attachment: Local organizations offering assistance to victims of domestic violence, dating violence, sexual assault, or stalking. Form HUD-5381 (06/2017) EMERGENCY TRANSFER U.S.Department of Housing OMB Approval No.2577-0286 REQUEST FOR CERTAIN and Urban Development Exp.06/30/2017 VICTIMS OF DOMESTIC VIOLENCE,DATING VIOLENCE, SEXUAL ASSAULT,OR STALKING Purpose of Form: If you are a victim of domestic violence, dating violence, sexual assault,or stalking, and you are seeking an emergency transfer,you may use this form to request an emergency transfer and certify that you meet the requirements of eligibility for an emergency transfer under the Violence Against Women Act(VAWA). Although the statutory name references women, VAWA rights and protections apply to all victims of domestic violence, dating violence, sexual assault or stalking.Using this form does not necessarily mean that you will receive an emergency transfer. See your housing provider's emergency transfer plan for more information about the availability of emergency transfers. The requirements you must meet are: (1)You are a victim of domestic violence,dating violence,sexual assault,or stalking. If your housing provider does not already have documentation that you are a victim of domestic violence, dating violence, sexual assault, or stalking,your housing provider may ask you for such documentation. In response, you may submit Form HUD-5382, or any one of the other types of documentation listed on that Form. (2) You expressly request the emergency transfer. Submission of this form confirms that you have expressly requested a transfer. Your housing provider may choose to require that you submit this form, or may accept another written or oral request. Please see your housing provider's emergency transfer plan for more details. (3) You reasonably believe you are threatened with imminent harm from further violence if you remain in your current unit. This means you have a reason to fear that if you do not receive a transfer you would suffer violence in the very near future. OR You are a victim of sexual assault and the assault occurred on the premises during the 90-calendar-day period before you request a transfer. If you are a victim of sexual assault, then in addition to qualifying for an emergency transfer because you reasonably believe you are threatened with imminent harm from further violence if you remain in your unit, you may qualify for an emergency transfer if the sexual assault occurred on the premises of the property from which you are seeking your transfer, and that assault happened within the 90-calendar-day period before you submit this form or otherwise expressly request the transfer. Submission of Documentation: If you have third-party documentation that demonstrates why you are eligible for an emergency transfer,you should submit that documentation to your housing provider if it is safe for you to do so. Examples of third party documentation include,but are not limited to: a letter or other documentation from a victim service provider, social worker, legal assistance provider,pastoral counselor,mental health provider,or other professional from whom you have sought assistance; a current restraining order;a recent court order or other court records; a law enforcement report or records; communication records from the perpetrator of the violence or family members or friends of the perpetrator of the violence,including emails,voicemails,text messages, and social media posts. Form HUD-5383 (06/2017) 2 Confidentiality: All information provided to your housing provider concerning the incident(s) of domestic violence, dating violence, sexual assault, or stalking, and concerning your request for an emergency transfer shall be kept confidential. Such details shall not be entered into any shared database. Employees of your housing provider are not to have access to these details unless to grant or deny VAWA protections or an emergency transfer to you. Such employees may not disclose this information to any other entity or individual, except to the extent that disclosure is: (i)consented to by you in writing in a time-limited release; (ii)required for use in an eviction proceeding or hearing regarding termination of assistance; or(iii)otherwise required by applicable law. TO BE COMPLETED BY OR ON BEHALF OF THE PERSON REQUESTING A TRANSFER 1. Name of victim requesting an emergency transfer: 2. Your name(if different from victim's) 3. Name(s) of other family member(s) listed on the lease: 4. Name(s) of other family member(s)who would transfer with the victim: 5. Address of location from which the victim seeks to transfer: 6. Address or phone number for contacting the victim: 7. Name of the accused perpetrator(if known and can be safely disclosed): 8. Relationship of the accused perpetrator to the victim: 9. Date(s),Time(s) and location(s) of incident(s): 10. Is the person requesting the transfer a victim of a sexual assault that occurred in the past 90 days on the premises of the property from which the victim is seeking a transfer? If yes,skip question 11.If no,fill out question 11. It. Describe why the victim believes they are threatened with imminent harm from further violence if they remain in their current unit. 12. If voluntarily provided,list any third-party documentation you are providing along with this notice: This is to certify that the information provided on this form is true and correct to the best of my knowledge, and that the individual named above in Item I meets the requirement laid out on this form for an emergency transfer. I acknowledge that submission of false information could jeopardize program eligibility and could be the basis for denial of admission,termination of assistance, or eviction. Signature Signed on(Date) Form HUD-5383 (06/2017) CERTIFICATION OF U.S. Department of Housing OMB Approval No.2577-0286 DOMESTIC VIOLENCE, and Urban Development Exp.06/30/2017 DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING, AND ALTERNATE DOCUMENTATION Purpose of Form: The Violence Against Women Act("VAWA")protects applicants,tenants, and program participants in certain HUD programs from being evicted, denied housing assistance,or terminated from housing assistance based on acts of domestic violence, dating violence,sexual assault, or stalking against them. Despite the name of this law,VAWA protection is available to victims of domestic violence,dating violence, sexual assault,and stalking,regardless of sex, gender identity, or sexual orientation. Use of This Optional Form: If you are seeking VAWA protections from your housing provider,your housing provider may give you a written request that asks you to submit documentation about the incident or incidents of domestic violence, dating violence, sexual assault, or stalking. In response to this request,you or someone on your behalf may complete this optional form and submit it to your housing provider, or you may submit one of the following types of third-party documentation: (1)A document signed by you and an employee, agent, or volunteer of a victim service provider, an attorney,or medical professional, or a mental health professional(collectively, "professional")from whom you have sought assistance relating to domestic violence,dating violence, sexual assault, or stalking, or the effects of abuse. The document must specify, under penalty of perjury,that the professional believes the incident or incidents of domestic violence,dating violence, sexual assault, or stalking occurred and meet the definition of"domestic violence,""dating violence,""sexual assault,"or "stalking"in HUD's regulations at 24 CFR 5.2003. (2)A record of a Federal, State,tribal,territorial or local law enforcement agency, court, or administrative agency; or (3)At the discretion of the housing provider, a statement or other evidence provided by the applicant or tenant. Submission of Documentation: The time period to submit documentation is 14 business days from the date that you receive a written request from your housing provider asking that you provide documentation of the occurrence of domestic violence,dating violence, sexual assault,or stalking. Your housing provider may,but is not required to, extend the time period to submit the documentation,if you request an extension of the time period. If the requested information is not received within 14 business days of when you received the request for the documentation,or any extension of the date provided by your housing provider,your housing provider does not need to grant you any of the VAWA protections. Distribution or issuance of this form does not serve as a written request for certification. Confidentiality: All information provided to your housing provider concerning the incident(s)of domestic violence, dating violence, sexual assault, or stalking shall be kept confidential and such details shall not be entered into any shared database. Employees of your housing provider are not to have access to these details unless to grant or deny VAWA protections to you, and such employees may not disclose this information to any other entity or individual, except to the extent that disclosure is: (i)consented to by you in writing in a time-limited release; (ii)required for use in an eviction proceeding or hearing regarding termination of assistance; or(iii)otherwise required by applicable law. Form HUD-5382 (06/2017) 2 TO BE COMPLETED BY OR ON BEHALF OF THE VICTIM OF DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, OR STALKING 1. Date the written request is received by victim: 2. Name of victim: 3. Your name (if different from victim's): 4. Name(s) of other family member(s) listed on the lease: 5. Residence of victim: 6. Name of the accused perpetrator(if known and can be safely disclosed): 7. Relationship of the accused perpetrator to the victim: 8. Date(s)and times(s) of incident(s) (if known): 10. Location of incident(s): In your own words,briefly describe the incident(s): This is to certify that the information provided on this form is true and correct to the best of my knowledge and recollection,and that the individual named above in Item 2 is or has been a victim of domestic violence, dating violence, sexual assault, or stalking. I acknowledge that submission of false information could jeopardize program eligibility and could be the basis for denial of admission, termination of assistance, or eviction. Signature Signed on(Date) Public Reporting Burden: The public reporting burden for this collection of information is estimated to average 1 hour per response. This includes the time for collecting, reviewing, and reporting the data. The information provided is to be used by the housing provider to request certification that the applicant or tenant is a victim of domestic violence, dating violence, sexual assault, or stalking. The information is subject to the confidentiality requirements of VAWA. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid Office of Management and Budget control number. Form HUD-5382 (06/2017) VIOLENCE,DATING VIOLENCE U.S.Department of Housing OMB Approval No.2502-0204 OR STALKING and Urban Development Exp.6/30/2017 Office of Housing LEASE ADDENDUM VIOLENCE AGAINST WOMEN AND JUSTICE DEPARTMENT REAUTHORIZATION ACT OF 2005 TENANT LANDLORD UNIT NO. &ADDRESS SPHINX AT SIERRA VISTA SENIOR VILLAS This lease addendum adds the following paragraphs to the Lease between the above referenced Tenant and Landlord. Purpose of the Addendum The lease for the above referenced unit is being amended to include the provisions of the Violence Against Women and Justice Department Reauthorization Act of 2005 (VAWA). Conflicts with Other Provisions of the Lease In case of any conflict between the provisions of this Addendum and other sections of the Lease, the provisions of this Addendum shall prevail. Term of the Lease Addendum The effective date of this Lease Addendum is This Lease Addendum shall continue to be in effect until the Lease is terminated. VAWA Protections 1. The Landlord may not consider incidents of domestic violence, dating violence or stalking as serious or repeated violations of the lease or other"good cause" for termination of assistance, tenancy or occupancy rights of the victim of abuse. 2. The Landlord may not consider criminal activity directly relating to abuse, engaged in by a member of a tenant's household or any guest or other person under the tenant's control, cause for termination of assistance, tenancy, or occupancy rights if the tenant or an immediate member of the tenant's family is the victim or threatened victim of that abuse. 3. The Landlord may request in writing that the victim, or a family member on the victim's behalf, certify that the individual is a victim of abuse and that the Certification of Domestic Violence, Dating Violence or Stalking, Form HUD-91066, or other documentation as noted on the certification form, be completed and submitted within 14 business days, or an agreed upon extension date, to receive protection under the VAWA. Failure to provide the certification or other supporting documentation within the specified timeframe may result in eviction. Tenant Date Landlord Date Form HUD-9I067 (9/2008)