HomeMy WebLinkAboutContract 42289-A5 CITY
CRMaNRA NO s 89 —45
FIFTH AMENDMENT TO CITY SECRETARY CONTRACT NO.42289
WHEREAS, the City of Fort Worth ("City') and Tarrant County Housing Partnership,
Inc. ("Developer")made and entered into City Secretary Contract No. 42289 (collectively with
the First through Third Amendments, the "Original Contract") to complete the rehabilitation
of a foreclosed 11 building apartment complex commonly known as the Beaty Street
Apartments;
WHEREAS, the Original Contract provided funding to Developer pursuant to a grant
received by City from the United States Department of Housing and Urban Development
("HUD")through the HOME Investment Partnerships Program ("HOME"), Catalog of Federal
Domestic Assistance No. 14.239;
WHEREAS, the HOME regulations require that 15% of the City's HOME grant funds
be set aside for housing to be developed, sponsored or owned by a Community Housing
Development Organization"CHDO", and Developer qualifies as a CHDO;
WHEREAS,City agreed to loan Developer$1,000,000.00 of its HOME CHDO set-aside
funds in the form of a subordinate loan to perform needed rehabilitation at the Beaty Street
Apartments, under the terms and conditions described in the Original Contract;
WHEREAS, City also agreed to loan the Developer$1,699,175.00 of its Neighborhood
Stabilization Program funds for acquisition of the property in the form of a aid lien subordinate
loan for the project under the terms and conditions of City Secretary Contract No. 42290, and
Developer obtained a $530,000.00 line of credit from Wells Fargo Bank, National Association,
for additional financing for the project;
WHEREAS, due to the age of the buildings as well as other unforeseen expenses
including asbestos and lead remediation, the rehabilitation costs exceeded the project budget by
$195,000.00 creating a gap in Developer's financing for the project;
WHEREAS, City identified $19,526.51 of HOME CHDO Reservation funds from 1998
that were available and City agreed to increase the HOME loan by that amount in the First
Amendment to the Original Contract in order to assist with the funding gap and to prevent the
City from losing the CHDO funds;
WHEREAS,City subsequently identified an additional$45,000.00 of 2006 HOME funds
and City agreed to further increase the HOME loan by that amount in the Second Amendment
to the Original Contract to further assist with the funding gap and to prevent the City from losing
the benefit of these funds;
WHEREAS,the total HOME loan after the First and Second Amendments to the Original
Contract was$1,064,526.51;
WHEREAS, a review of the project identified potential tenants deemed to be eligible for
relocation payments under the Uniform Relocation Act or("URA"), and City Council approved
an additional$265,000.00 of HOME Funds and an extension of the original 2-year contract term
for the project in order to meet URA requirements (M&C C-26586);
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OFFICIAL RECORD
R�C CHDO CONTRACT CSC No.42289 5111 Amendment R v40"WRETARY
DEC 2 4 V9g Channel-Beaty Street Apartments P ge h WORTH,
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WHEREAS, the total HOME loan after the Third Amendment to the Original Contract
was $1,329,526.51 and the contract term was extended to 6 years to meet URA requirements;
WHEREAS, inspections of the project in 2016 revealed the need for additional
rehabilitation to ensure that all units met HOME Property Standards and would be fully
sustainable for the HUD-required affordability period;
WHEREAS, Developer applied to City in 2016 for funds for the additional rehabilitation
needs, and City's Community Development Council recommended an additional $277,075.00
of HOME funds be awarded to Developer for a portion of these additional costs;
WHEREAS, Developer subsequently performed a capital needs assessment on the
project and determined that a total of$1,252,838.68 was needed to complete the rehabilitation
in order to ensure the project's continued sustainability for the affordability period;
WHEREAS, City identified an additional $1,319,708.93 of HOME CHDO funds for the
project and agreed to refinance the line of credit and the HOME loan into a deferred forgivable
no interest loan in order to increase the financial viability of the project and to ensure its long
term sustainability;
WHEREAS, the City amended its 2013-2018 Consolidated Plan to add HOME Program
refinancing guidelines setting out the requirements for multifamily housing projects that may be
considered eligible for refinancing of private mortgage debt with the use of HOME funds;
WHEREAS,City and Developer agreed to the Fourth Amendment in order to amend and
restate the Original Contract to complete the rehabilitation of the project and to assist City in
meeting its HOME CHDO commitment and spending goals. The agreement between the Parties
in the Fourth Amendment substituted and superseded the terms of the Original Contract
(hereinafter, the"Contract");
WHEREAS, the total HOME loan after the Fourth Amendment was $2,926,310.44;
WHEREAS, Developer has completed repairs under the Contract and has identified
additional foundation repairs and resulting interior drywall cracks in the amount of$30,220.00;
WHEREAS,the HOME Regulations require each jurisdiction participating in the HOME
Program to make contributions to qualified housing in an amount equal to 25% of appropriated
HOME funds drawn down for housing projects ("Match");
WHEREAS,the project is a partially HOME-assisted project, and City wishes to make a
permanent contribution from nonfederal sources to cover the additional repairs to count as
Match;
WHEREAS, the City's contribution of$30,220.00 to the project will be made from the
City's general funds and not from federal funds provided by the United States government or
any agency thereof, or the proceeds of an obligation the interest on which is exempt from federal
tax;
HOME CHDO CONTRACT CSC No.42289 5"Amendment Rev. 11/19/2019
Housing Channel-Beaty Street Apartments Page 2
WHEREAS, the new loan amount after this Fifth Amendment will be$2,956,530.44;
WHEREAS, the line item amounts listed in Exhibit "B" — Budget need to reflect the
addition of City general funds as Match;
WHEREAS, due to unforeseen delays, Developer has requested an extension to the
Completion Deadline;
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 City and Developer to amend the Contract to
complete the project and meet Contract objectives.
NOW, THEREFORE, City and Developer hereby agree to amend the Contract as
follows:
I.
The following definitions in Section 2 in the Contract are amended to be and read as
follows:
"Completion Deadline means December 31, 2019."
"Loan or Loan proceeds means the combined HOME Funds and City general funds
provided to Developer by City under the terms of this Contract as more particularly
described in the Loan Documents."
"Promissory Note means any note in the amount of the Loan executed by Developer payable to
the order of City, as the same may be extended, amended, restated, supplemented or otherwise
modified. The form of the Promissory Note is attached as Exhibit"E"—Loan Documents.
The following definitions are added to the Contract:
"HOME Match or Match means a permanent contribution from nonfederal sources to
housing that qualifies as affordable under HOME Regulations.
"HUD Notice means HUD Notice CPD 97-03 regarding HOME Program Match Guidance."
11.
Section 4.1 Provide HOME funds is amended to be and read as follows:
"4.1 Provide Loan.
City shall provide up to $2,926,310.44 of HOME Funds and $30,220.00 of the
City's general funds in the form of the Loan for the refinancing of previous loans on the
project and the cost of completing the rehabilitation of the Required Improvements,under
the terms and conditions of this Contract and the Loan Documents."
HOME CHDO CONTRACT CSC No.42289 5"Amendment Rev. 11/19/2019
Housing Channel-Beaty Street Apartments Page 3
III.
Section 5.2 Use of HOME Funds is amended to be and read as follows:
"5.2 Use of Loan Proceeds.
5.2.1 Costs in Compliance with HOME Regulations and Contract.
Developer shall be reimbursed for eligible project costs with Loan proceeds only
if City determines in its sole discretion that:
5.2.1.1 Costs are eligible expenditures in accordance with the HOME
Regulations.
5.2.1.2 Costs are in compliance with this Contract and are reasonable and
consistent with industry norms.
5.2.1.3 Complete Documentation, as applicable, is submitted by Developer.-
Section 5.2.2 Budget is amended to be and read as follows:
"5.2.2 Budget.
Developer agrees that the Loan proceeds will be paid on a reimbursement basis in
accordance with Exhibit"B" -Budget and Exhibit "C" -Construction and Reimbursement
Schedule. Developer may increase or decrease line item amounts in the Budget with the
Director's prior written approval,which approval shall be in the Director's sole discretion. Any
such increase or decrease in line items in the Budget shall comply with Section 5.2.1, Exhibit
"A—Project Summary, and shall not increase the total amount of the Loan. Section 5 is
amended by adding new Section 5.2.4:
"5.2.4 Contributions to HOME-Assisted Housing and Compliance with
Contract.
City will make a permanent contribution of non-federal funds to the portion of
the project that is not HOME-assisted to be counted as Match in accordance with the
HOME Regulations. Developer will operate as the owner of the HOME-assisted housing
under this Contract as set forth in the HUD Notice and will ensure compliance with the
applicable requirements for HOME-assisted projects as provided therein and in the
HOME Regulations including any required compliance after initial occupancy of the
project."
Sections 5.3, 5.4, 5.5 and 5.6 are amended to be and read as follows:
"5.3 Payment of Loan Proceeds to Developer.
Loan Proceeds will be disbursed to Developer upon City's approval of Developer's
Reimbursement Requests, including submission of Complete Documentation to City in
compliance with Section 10. It is expressly agreed by the Parties that any Loan Proceeds not
reimbursed to Developer shall remain with City.
"5.4 Identify Project Expenses Paid with Loan Proceeds.
HOME CHDO CONTRACT CSC No.42289 5"Amendment Rev. 11/19/2019
Housing Channel-Beaty Street Apartments Page 4
Developer will keep accounts and records in such a manner that City may readily identify
and account for project expenses reimbursed with Loan Proceeds. These records shall be made
available to City for audit purposes and shall be retained as required hereunder.
"5.5 Acknowledgement of City Payment of Loan Proceeds.
Within 90 days of Completion, Developer shall sign an acknowledgement that City has
paid all HOME Funds due under this Contract,or shall deliver a document executed by an officer
of Developer identifying all or any portion of the Loan proceeds that City has not paid to
Developer. Once City has met all of its obligations for payment of Loan proceeds hereunder, an
officer of Developer shall sign an acknowledgement of same.
"5.6. Security for City's Interest and Developer's Performance.
To secure City's interest in the Required Improvements and the performance of
Developer's obligations hereunder,Developer shall execute the Loan Documents and record the
Deed of Trust encumbering the Property. No Loan Proceeds will be paid or reimbursed until the
Deed of Trust is recorded."
The following subsections of Section 5.6.1 Loan Terms and Conditions are amended to be and
read as follows:
"5.6.1.7 The Loan is a forgivable deferred payment loan. Repayment of the
Loan will only be required if Developer does not meet the
Affordability Requirements during the Affordability Period, or
Developer does not otherwise comply with the terms of this Contract,
the NSP Contract, the NSP loan documents, the Loan Documents, or
the HOME Regulations.
"5.6.I.9 Early repayment of the Loan shall not relieve Developer of its
obligations under this Contract or the HOME Regulations including
but not limited to the Affordability Requirements and other HOME
requirements. The Deed of Trust shall secure both repayment of the
Loan and performance by Developer of its obligations under this
Contract during the Affordability Period.
Section 5.8 Affordability Requirements Survive Transfer is amended to be and read as
follows:
"5.8 Affordability Requirements Survive Transfer.
The HOME Units must remain affordable without regard to the term of any mortgage or
transfer of ownership, pursuant to the terms of the Loan Documents, any deed restrictions or
other mechanism provided by HUD. Any sale or transfer of the project during the Affordability
Period, excluding a transfer due to condemnation or to obtain utility services, may at City's sole
discretion require the repayment of the Loan unless the new owner or transferee affirmatively
assumes in writing the obligations established hereunder for the HOME Units for whatever time
remains of the Affordability Period. Failure of the new owner or transferee to promptly assume
all of Developer's obligations under this Contract and the Loan Documents will result in
immediate termination of this Contract and any Loan proceeds already paid to Developer must
be repaid to City within 30 days of such termination. In addition, City may pursue any of its
HOME CHDO CONTRACT CSC No.42289 51'Amendment Rev. 11/19/2019
Housing Channel-Beaty Street Apartments Page 5
remedies under the Loan documents if the new owner or transferee fails to assume Developer's
obligations to maintain the Affordability Requirements throughout the Affordability Period."
IV.
Section 7 TENANT AND LEASE REQUIREMENTS; PROPERTY STANDARDS
DURING AFFORDABILITY PERIOD is amended by adding new Section 7.10:
"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 "M" — 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
"M" —VAWA Forms or its own form that is substantially the same."
V.
Section 12 REPAYMENT OF HOME FUNDS is amended to be and read as follows:
"12. REPAYMENT OF LOAN.
All Loan funds, whether HOME Funds or City general funds, are subject to
repayment in the event the project does not meet the requirements as set out in this
Contract or in the HOME Regulations. If Developer takes any action that results in
City being required to repay all or any portion of the HOME Funds to HUD,
Developer agrees it will reimburse City for such repayment. If Developer takes any
action that results in City receiving a finding from HUD about the project,whether
or not repayment to HUD is required of City,Developer agrees it will pay City 10%
of the HOME Funds as liquidated damages. The Parties agree that the City's
damages in the event of either repayment to HUD being required or receiving a
finding from HUD are uncertain and would be difficult to ascertain and may include
an impact on City's HOME grant or other Federal grant funds, in addition to a
finding by HUD or a repayment of funds to HUD by City. Therefore, the Parties
agree that payment under this Section of 10% of the HOME Funds by Developer to
City is liquidated damages and not a penalty.
HOME CHDO CONTRACT CSC No.42289 51'Amendment Rev. 11/19/2019
Housing Channel-Beaty Street Apartments Page 6
agree that payment under this Section of 10% of the HOME Funds by Developer to
City is liquidated damages and not a penalty.
VI.
All references in the Contract to "HOME Funds" shall be changed to the "Loan" or "Loan
proceeds" as appropriate to the context of the section unless such section clearly applies only to the
HOME Funds and/or the HOME Regulations governing the use of the HOME Funds. It is the intention
of this amendment to reflect that the Loan consists of both HOME Funds and City general funds and
this understanding should govern the reading of all pertinent terms and provisions of this Contract. Any
references to the payment by Developer of liquidated damages to City shall only include the HOME
Funds.
VII.
Exhibit"B"—Budget and Exhibit"C"—Construction and Reimbursement Schedule
attached to the Contract are hereby replaced with Exhibit "B" —Budget Revised 11/2019 and
Exhibit"C"—Construction and Reimbursement Schedule Revised 11/2019 attached hereto.
Exhibit "M" —VAWA Forms attached hereto is added to the Contract.
VIII.
This amendment is effective as of the Effective Date of the Contract.
IX.
All other terms and conditions of City Secretary Contract No. 42289 not amended herein
remain unaffected and in full force and effect, are binding upon the Parties, and are hereby
ratified by the Parties. Capitalized terms not defined herein shall have meanings assigned to
them in the Contract.
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HOME CHDO CONTRACT CSC No.42289 51h Amendment Rev. 11/19/2019
Housing Channel-Beaty Street Apartments Page 7
[REMAINDER OF PAGE LEFT INTENTIONALLY BLANK]
[SIGNATURE PAGE TO FOLLOW]
HOME CHDO CONTRACT CSC No.42289 5'Amendment Rev. 11/19/2019
Housing Channel-Beaty Street Apartments Page 8
ACCEPTED AND AGREED:
�0
ATTEST: U . �-- ;?�ITY OF FORT WORTH
Ci ecreta Fernand Cos a, Assistant City Manager
M C: C-28409 ated Septembe � y» � �` Date:
Form 1295:
APPROVED AS TO FORM AND LEGALITY:
k--t(A,VU_ 4 , I A&-1t4kk1
Vicki S. Ganske, Senior Assistant City Attorney
HO ING C
o a ss,By:
Date:
City of Fort Worth Contract Compliance Manager
By signing I acknowledge that I am the person responsible
Fort the monitoring and administration of this contract, including
Ensuring all performance and reporting requirements.
Chad LaRoque
Housing Development and Grants Manager
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH,TX
HOME CHDO CONTRACT CSC No.42289 5"Amendment R
Housing Channel-Beaty Street Apartments Page 9
EXHIBIT "B"
BUDGET Revised 11/2019
HOUSING CHANNEL
Beaty Street Apartments Project
Total Cost: $1,845,935.93
Project HOME Funds Awarded: $1,815,715.93
Project General Funds Awarded: $30,220.00
HOME Funds and City General Funds will be paid only as reimbursement for eligible expenses.
Development Budget
Use of Funds Source of Funds
Predevelopment Cost HOME$ CITY'S$ SOURCE OF TOTAL$
GENERAL OTHER
FUNDS FUNDS FUNDS FUNDS
-1 -2 (Names) (1+2)
1.Market Study
2.Feasibility(i.e.:preliminary work write-up,cost
estimates,design)
3.Other
Total Predevelopment Cost(1+2=3)
Development Cost
4.Land and/or building acquisition
5. Site Preparation(included in Line Item 6)
6.Construction Cost $1,087,098.72
7.Fence
8. Landscape $2,726.64
9. Contingency
10. Concrete $137,726.51
11. Roofing $71,384.00
12.Foundation $4,705.00 $30,220.00
13.Construction Loan Interest
14. Property Survey
15. Legal Fees
16.Real Estate Fees
17. Utility Hookup/Impact Fees
18.Title&Recording Fees
19. Program Related Expenses
20. Construction Management Fee $90,000.00
21. Other: Wells Fargo Loan Payoff $422,075.06
Total Development Cost(Total of items 4-21)
Total Project Cost $1,815,715.93 $30,220.00 $1.845,935.93
HOME CHDO CONTRACT Exhibit`B"—Budget Rev. 11/10/2019
Housing Channel,Inc.—Beaty Street Apartments
EXHIBIT "C"
CONSTRUCTION AND REIMBURSEMENT SCHEDULE Revised 11/2019
HOUSING CHANNEL
Beaty Street Apartments
Beginning Week—subject to
Phase Activity weather permitting
PHASE I ACTIVITIES: Contract Signed 11/28/2017
Landscaping,Roofing,Appliances 10/1/2018
PHASE I DEADLINE: AMOUNT$123 037.21
12/1/2018 1st Payment* '
PHASE II ACTIVITIES: Parking Lot,Exterior Rehab,Roofing 1/1/2019
Electrical,Laundry Room Rehab
PHASE II DEADLINE: 2'payment* AMOUNT$120,566.98
3/01/2019
PHASE III ACTIVITIES: Parking Lot,Electrical,Exterior Rehab 2/1/2019
PHASE IV DEADLINE: 3'payment* AMOUNT$125,553.60
4/01/2019
PHASE V ACTIVITIES: Exterior Rehab,HVAC,Plumbing 3/01/2019
PHASE IV DEADLINE: 4te payment* AMOUNT$99,593.10
5/01/2019
PHASE V1 ACTIVITIES: Interior Rehab 4/01/2019
PHASE IV DEADLINE: 5te Payment* AMOUNT$66,555.21
6/01/2019
PHASE VII ACTIVITIES: Interior Rehab 5/01/2019
PHASE IV DEADLINE: 6'payment* AMOUNT$117,864.66
7/01/2019
PHASE VIII ACTIVITIES: Interior Rehab,Electrical 6/01/2019
PHASE IV DEADLINE:8/01/2019 7tn payment* AMOUNT$166,770.73
PHASE IX ACTIVITIES: Interior Rehab,Landscaping 7/01/2019
PHASE IV DEADLINE: 8'payment* AMOUNT$202,555.30
9/1/2019
PHASE X ACTIVITIES: Interior Rehab,Electrical,Landscaping 8/01/2019
PHASE IV DEADLINE: 9'payment* AMOUNT$277,539.08
9/30/2019
PHASE XI ACTIVITIES: Foundation repairs 10/31/2019
PHASE V DEADLINE: FINAL PAYMENT** AMOUNT$33,825
12/31/2019
HOME CHDO CONTRACT Exhibit"C"—Project and Reimbursement Schedule Rev. 11/10/2019
Housing Channel—Beaty Street Apartments
CONSTRUCTION TOTAL $1,333,860.87
CONSTRUCTION $90,000
MANAGEMENT FEE***
*Developer will be reimbursed for eligible expenses only. 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 CHDO CONTRACT Exhibit"C"—Project and Reimbursement Schedule Rev. 11/10/2019
Housing Channel—Beaty Street Apartments
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
[Housing Channel—Beaty Street Apartments']
Notice of Occupancy Rights under the Violence Against Women A&
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.
2 Despite the name of this law,VAWA protection is available regardless of sex,gender identity,or sexual
orientation.
3 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 if:
• 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)
VIOLENCE,DATING VIOLENCE U.S. Department of Housing OMB Approval No.2502-0204
OR STALKING and Urban Development Exp.6/3012017
Office of Housing
LEASE ADDENDUM
VIOLENCE AGAINST WOMEN AND JUSTICE DEPARTMENT REAUTHORIZATION ACT OF 2005
TENANT LANDLORD UNIT NO.&ADDRESS
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-91067
(9/2008)
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.
11. 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 1 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)
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 06/30/2017
[Housing Channel—Beaty Street Apartments]
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 program 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://ohl.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-reso urce-center.
Attachment: Local organizations offering assistance to victims of domestic violence, dating
violence, sexual assault, or stalking.
Form HUD-5381
(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 infonnation 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.
Forn HUD-5382
(06/2017)