Certification of Owner Eligibility

U .S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT

WASHINGTON, DC 20410-3000

Office of Housing

Multifamily Energy and Water Conservation Pay for Success (PFS) Pilot

CERTIFICATION OF OWNER ELIGIBILITY

NAME OF PROPERTY OWNER: ____________________________

As the Owner of the HUD-assisted Property with iREMS number _________________ located at _________________________________, I certify that to my knowledge the following is true:

1. The Property Owner compliance with all business agreements with the Department and project operations standards (check one):

• The Property Owner is in compliance with all business arrangements and project operations standards

• Current non-compliance will be cured through participation in the Multifamily Energy and Water Conservation PFS Pilot (requires attachment of a statement from the HUD field office with jurisdiction that program participation can reasonably be expected to cure all outstanding non-compliance issues)

2. The Property Owner is in current compliance with all applicable fair housing and civil rights requirements contained in 24 CFR 5.105(a), including the Fair Housing Act and its physical accessibility requirements, Title VI of the Civil Rights Act of 1964, Title II of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act of 1973, and their implementing regulations, and submit a certification of compliance with these requirements.

3. The Property has a current Real Estate Assessment Center (REAC) Physical Assessment Subsystem (PASS) score of 60 or above.

4. Property Management and Occupancy Review (MOR) rating (check one):

• The Property has received satisfactory Management and Occupancy Review ratings for its most recent MOR

• The Property received a less than satisfactory rating in one or more sections of its last MOR but corrective action has been taken (requires attachment of a written statement regarding the status of any corrective action in progress, target dates for completing these actions, and any other corrective actions taken)

5. The Owner is current in the submission of Annual Financial Statements in the form required by the Department and Monthly Accounting Reports for the prior three-year period and Excess Income Reports for the prior seven-year period, and has resolved any existing compliance flags. All excess income, regardless of the time frame, owed to the Department must be paid in full prior to execution of the PFS Contract.

I also certify that to the best of my knowledge, all information submitted concerning the conversion of units is true, correct and complete.

Warning: 18 U.S.C. 1001 provides, in part, that whoever knowingly and willingly makes or uses a document or writing containing any false, fictitious, or fraudulent statement or entry, in any matter within the jurisdiction of any department or agency of the United States shall be fined not more than $10,000 or imprisoned for not more than 5 years, or both.

Signed,

____________________________________________ __________________

Signature Date

____________________________________________

Print Name

Page 2 of 2