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Agenda 09/10/2024 Item #16D 4 (Community Development Block Grant Subrecipient Agreement #PS22-05 between Collier County and Housing Development Coporation Inc.)16.D.4 09/10/2024 EXECUTIVE SUMMARY Recommendation to approve and authorize the Chairman to sign a Community Development Block Grant Subrecipient Agreement #PS22-05 between Collier County and Housing Development Corporation Inc., d/b/a HELP in the amount of $69,000 for housing and financial counseling services. (Grant Fund 1835, CDBG Project 33823) OBJECTIVE: To support and further the County's strategic plan by promoting comprehensive affordable housing opportunities for low- to moderate -income citizens of Collier County. CONSIDERATIONS: The U.S. Department of Housing and Urban Development (HUD) provides entitlement funds to allow local governments to meet program -specific community needs. Entitlement programs include Community Development Block Grant (CDBG), which can be used to fund a wide variety of projects such as public services, public infrastructure, and public facilities. On June 22, 2021, the Board of County Commissioners (Board) approved the County's Five -Year Consolidated Plan for the use of entitlement funds for the period of Program Year (PY) 2021-2025 (Agenda Item #16.D.7). As part of the County's 5-year Consolidated Plan, the Community and Human Services (CHS) Division is required to adopt and submit an Annual Action Plan each year. On June 28, 2022, the Board approved the FY2022-2023 Annual Action Plan (Agenda Item #16.D.4). On May 28, 2024, (Agenda Item 16.D.4) the Board approved the Substantial Amendment to the County's PY 2022-2023 Action Plan to address additional funding, reprogramming of funds from previous years, and new activities related to Community Development Block Grant (CDBG). The proposed agreement, #PS22-05, in the amount of sixty-nine thousand ($69,000), will be administered by the Housing Development Corporation Inc., d/b/a HELP and will provide funding to create and implement a Housing Navigator Program to provide information on resources for both homeownership and attainable rentals to current and future residents of Collier County to affirmatively further fair housing. This program is an expansion of the established Home Buyer Academy. The agreement term is May 28, 2024, to align with the substantial amendment effective date, and will expire on September 30, 2024. FISCAL IMPACT: There is no new Fiscal impact for this recommendation. Funds for the Agreement are located in Housing Grant Fund (1835), CDBG Project 33823. LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires majority vote for Board approval. -CJS GROWTH MANAGEMENT IMPACT: Federal HUD funding assists the County in addressing some of the goals and objectives of the Housing Element in the Growth Management Plan. RECOMMENDATION: To approve and authorize the Chairman to sign a Community Development Block Grant Subrecipient Agreement #PS22-05 between Collier County and Housing Development Corporation Inc., d/b/a HELP in the amount of $69,000 for housing and financial counseling services. Prepared By: Julie Chardon, Grant Coordinator 1, Community and Human Services Division ATTACHMENT(S) 1. [linked] HELP PS22-05 Signed Agreement (PDF) 2. SAM - HELP (PDF) 3. Sunbiz HELP (PDF) 4. Certificate of Insurance -HELP (PDF) 5. My Company Profile _ E-Verify(PDF) Packet Pg. 921 16.D.4 09/10/2024 6. W9_HELP (PDF) 7. Collier Business Tax 10.1.23-9.30.24 (PDF) 8. Collier Business Tax 10.1.24-9.30.25 (PDF) 9. HELP Insurance Cert - 8-18-25 (PDF) Packet Pg. 922 16. D.4 09/10/2024 COLLIER COUNTY Board of County Commissioners Item Number: 16.D.4 Doc ID: 29492 Item Summary: Recommendation to approve and authorize the Chairman to sign a Community Development Block Grant Subrecipient Agreement #PS22-05 between Collier County and Housing Development Corporation Inc., d/b/a HELP in the amount of $69,000 for housing and financial counseling services. (Grant Fund 1835, CDBG Project 33823) Meeting Date: 09/10/2024 Prepared by: Title: — Community & Human Services Name: Julie Chardon 07/23/2024 2:00 PM Submitted by: Title: Manager - Federal/State Grants Operation — Community & Human Services Name: Kristi Sonntag 07/23/2024 2:00 PM Approved By: Review: Community & Human Services Darrick Gartley PSD Reviewer Completed 07/29/2024 1:01 PM Community & Human Services Mark Kadlec PSD Reviewer Completed 07/30/2024 10:32 AM Community & Human Services Donald Luciano PSD Reviewer Completed 07/31/2024 3:32 PM Community & Human Services Vanessa Collier PSD Reviewer Completed 08/02/2024 7:37 AM Community & Human Services Kristi Sonntag CHS Review Completed 08/05/2024 10:15 AM Operations & Veteran Services Jeff Weir OVS Director Review Completed 08/05/2024 4:12 PM Public Services Department Todd Henry Level 1 Department Review Completed 08/06/2024 11:22 AM County Attorney's Office Carly Sanseverino Level 2 Attorney Review Completed 08/06/2024 11:37 AM Corporate Compliance and Continuous Improvement Megan Gaillard Additional Reviewer Completed 08/20/2024 11:13 AM Grants Erica Robinson Level 2 Grants Review Completed 08/21/2024 3:40 PM Office of Management and Budget Blanca Aquino Luque Level 3 OMB Gatekeeper Review Completed 08/21/2024 3:46 PM Office of Management and Budget Blanca Aquino Luque OMB Reviewer Completed 08/22/2024 11:30 AM Public Services Department Tanya Williams PSD Department Head Review Completed 08/22/2024 12:01 PM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 08/23/2024 8:08 AM County Manager's Office Amy Patterson Level 4 County Manager Review Completed 09/03/2024 3:14 PM Board of County Commissioners Geoffrey Willig Meeting Pending 09/10/2024 9:00 AM Packet Pg. 923 Last updated by Michael Puchalla on Sep 22, 2023 at 02: 59 PM HOUSING DEVELOPMENT CORPORATION OF SW FLORIDA, INC. ���_JAM*GOW 16.D.4.b HOUSING DEVELOPMENT CORPORATION OF SW FLORIDA, INC. Unique Entity ID CAGE / NCAGE Purpose of Registration J3YVCLMWVKM7 5YXA7 All Awards Registration Status Expiration Date Active Registration Sep 21, 2024 Physical Address Mailing Address 3200 Bailey LN 3200 Bailey LN STE 109 STE 109 Naples, Florida 34105 Naples, Florida 34105-8506 United States United States Doing Business as Division Name Division Number :r HOUSING DEVELOPMENT CORP OF SW (blank) (blank) FLORIDA INC N Congressional District State / Country of Incorporation URL Florida 19 Florida / United States www.floridahelp.org Q ul) Registration Dates 0N Activation Date Submission Date Initial Registration Date N W CL Oct 10, 2023 Sep 22, 2023 Apr 14, 2010 0 m Entity Dates U Entity Start Date Fiscal Year End Close Date IL J Aug 1, 2003 Dec 31 W Immediate Owner 04 CAGE Legal Business Name rn obi (blank) (blank) a Highest Level Owner I j 2 CAGE Legal Business Name (blank) (blank) Q Executive Compensation } c Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 c aD E P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is v sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registre a responded to the questions. Q Proceedings Questions Registrants in the System for Award Management (SAM.gov) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209- or 2. C.F.R. 200 Appendix XII. Their responses are displayed in the responsibility/qualification section of SAM.gov. Maintaining an active registration in SAM.gov demonstrates the registrant responded to the proceedings questions. Active Exclusions Records? No I authorize my entity's non -sensitive information to be displayed in SAM public search results: Yes Business Types Entity Structure Entity Type Organization Factors packet P 924 Mar 14, 2024 12. 49: 49 PM GMT g' https:llsani.govlentityIJ3YVCLMWVKM71coreData?status=null age o Last updated by Michael Puchalla on Sep 22, 2023 at 02: 59 PM HOUSING DEVELOPMENT CORPORATION OF SW FLORIDA, INC. Corporate Entity Exempt) Business Organization 16.D.4.b (Tax or (blank) Profit Structure Non -Profit Organization Socio-Economic Types Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA -certified HUBZone sm+ business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed tI SBA supplemental pages during registration. Accepts Credit Card Payments Debt Subject To Offset No No EFT Indicator CAGE Code 0000 5YXA7 Electronic Business 3200 Bailey Lane STE 109 Michael Puchalla, Executive Director Naples, Florida 34105 m E United States a) N L Michael Puchalla 3200 Bailey Lane STE 109 a Naples, Florida 34105 United States G (4 Government Business N 0) a 9, 3200 Bailey Lane STE 109 Michael Puchalla, Executive Director Naples, Florida 34105 m ❑ United States U a - Michael Puchalla 3200 Bailey Lane STE 109 J W Naples, Florida 34105 2 United States N Q> Past Performance chi N_ 3200 Bailey Lane STE 109 d Michael Puchalla Naples, Florida 34105 J W United States 2 Michael Puchalla 3200 Bailey Lane STE 109 Naples, Florida 34105 United States C N V NAICS Codes <4 a Primary NAICS Codes NAICS Title Yes 624229 Other Community Housing Services Disaster Response This entity does not appear in the disaster response registry. Mar 14, 2024 12.49:49 PM GMT Packet Pg. 925 https:llsani.govlentityIJ3YVCLMWVKM71coreData?status=null age _ 5/9/24, 10:19 AM Detail by Entity Name DIVISION OF CORPORATIONS org'r�,z�������rrrrJ�r wi gffirialwe ofFlorida w-ekite Department of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Not For Profit Corporation HOUSING DEVELOPMENT CORPORATION OF SW FLORIDA, INC. Filing Information Document Number N03000008167 FEI/EIN Number 38-3695928 Date Filed 09/22/2003 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 01/08/2018 Event Effective Date NONE Principal Address 3200 BAILEY LANE SUITE #109 NAPLES, FL 34105 Changed: 11 /03/2011 Mailing Address 3200 BAILEY LANE SUITE #109 NAPLES, FL 34105 Changed: 11 /03/2011 Registered Agent Name & Address Puchalla, Michael 3200 BAILEY LANE SUITE 109 NAPLES, FL 34105 Name Changed: 01/06/2021 Address Changed: 02/15/2012 Officer/Director Detail Name & Address Title Executive Director r c a� E a� a� L Q LO 0 N N to a 0 m V a J w 2 N M rn F4 a J w 2 N c N r c a� E V Q https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrd Packet Pg. 926 5/9/24, 10:19AM Puchalla, Michael 3200 Bailey Lane Suite 109 Naples, FL 34105 Title Director Ribot, Frances 3200 Bailey Lane 109 Naples, FL 34105 Title Director Fedorko, Tara 3200 BAILEY LANE SUITE #109 NAPLES, FL 34105 Title Director Golden, Susan 3200 BAILEY LANE SUITE #109 NAPLES, FL 34105 Title Director Cook, Dottie 3200 BAILEY LANE SUITE #109 NAPLES, FL 34105 Title Director Paul, Matt 3200 BAILEY LANE SUITE #109 NAPLES, FL 34105 Annual Reports Report Year Filed Date 2022 01 /07/2022 2023 01 /19/2023 2024 02/05/2024 Document Images Detail by Entity Name 02/05/2024 --ANNUAL REPORT View image in PDF format 01/19/2023 --ANNUAL REPORT View image in PDF format 01/07/2022 --ANNUAL REPORT View image in PDF format 01/06/2021 --ANNUAL REPORT View image in PDF format 01/18/2020 --ANNUAL REPORT View image in PDF format 04/18/2019 --ANNUAL REPORT View image in PDF format 01/10/2018 --ANNUAL REPORT View image in PDF format I 16.D.4.c I r c a� E a� a� L Q LO 0 N N N a 0 m v a J W x N M rn a J W x N_ c N r c a� E t Q https:// search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&search Packet Pg. 927 1 5/9/24, 10:19 AM Detail by Entity Name 01/08/2018 --Amendment View image in PDF format 01/10/2017 --ANNUAL REPORT View image in PDF format 03/08/2016 --ANNUAL REPORT View image in PDF format 01/09/2015 --ANNUAL REPORT View image in PDF format 02/26/2014 --ANNUAL REPORT View image in PDF format 05/13/2013 --AMENDED ANNUAL REPORT View image in PDF format 05/02/2013 --ANNUAL REPORT View image in PDF format 02/15/2012 --ANNUAL REPORT View image in PDF format 01/05/2011 --ANNUAL REPORT View image in PDF format 08/11/2010 -- ANNUAL REPORT View image in PDF format 02/09/2009 --ANNUAL REPORT View image in PDF format 01/23/2009 -- Name Change View image in PDF format 01/23/2009 --Amendment View image in PDF format 07/07/2008 --ANNUAL REPORT View image in PDF format 04/11/2007 -- ANNUAL REPORT View image in PDF format 03/24/2006 --ANNUAL REPORT View image in PDF format 05/02/2005 --ANNUAL REPORT View image in PDF format 07/14/2004 --ANNUAL REPORT View image in PDF format 09/22/2003 -- Domestic Non -Profit View image in PDF format Florida Department of State, Division of Corporations C N L a LO O N N W a m 0 U a J W 2 N Cn G1 N a J W 2 N_ C 3 N C E t V M rr Q https:Hsearch.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOr Packet Pg. 928 DATE (M 16.D.4.d I ACORDTM CERTIFICATE OF LIABILITY INSURANCE I 8/11/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lana James Acrisure dba Gulfshore Ins SWF NAME: PHONE , El): 239 261-3646 FAX No, 239 213-2803 A/C, No 4100 Goodlette Road N E-MAIL @9 ADDRESS: ames II ulfshoreinsurance.com Naples, FL 34103 INSURER(S) AFFORDING COVERAGE NAIC# 239 261-3646 11000 INSURED Client#: 66315 HOUDE Housing Development Corp of SW Florida, Inc. 3200 Bailey Lane, Ste. 109 Naples, FL 34105 INSURER A: Sentinel Insurance Company INSURER B : Associated Industries 23140 INSURER C : RLI Insurance Company 13056 INSURER D : Travelers Casualty & Surety Co of Amer 31194 INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 21 SBMBW5724 8/18/2023 08/18/2024 EACH OCCURRENCE $1 000,000 CLAIMS -MADE � OCCUR PREMISES ERENTED r nce $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY I JROT LOC PRODUCTS -COMP/OP AGG $21000,000 $ OTHER: A AUTOMOBILE LIABILITY 21SBMBW5724 8/18/2023 08/18/202 MBINED INGLE LIMIT (CEO, cid.n1S 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N / A AWC1192618 3/22/2023 03/22/2024 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Prof Liability RTP0028866 3/22/2023 03/22/2024 $500,000 Ded $1,000 D Crime 107163108 10/07/2022 10/07/2023 $1,000,000 Ded $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is included as Additional Insured on a primary and noncontributory basis with regards to General Liability only as required by written contract per form SS008 0405, includes ongoing and completed operations, Waiver of Subrogation in favor of Additional Insured. CERTIFICATE HOLDER CANCELLATION Collier County, c/o Community and Human Services Division Department 3339 E. Tamiami Trail,; Suite 211 Naples, FL 34112 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE c d E d m L Q t19 O N N to a 0 m f7 U a- J W N 0) © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD Packet Pg. 929 #S1994574/M1994571 LJJ22 ME An official website of the United States government Here's how you know 16.D.4.e E-Verify My Company Account My Company Profile Company Information Company Name Housing Development Corporation of SW Florida, Inc Company ID 1419899 Employer Identification Number (EIN) 383695928 DUNS Number 830181330 NAICS Code 624 Subsector Social Assistance Edit Company Information Doing Business As (DBA) Name HELP Enrollment Date Jun 07,2019 Unique Entity Identifier (UEI) J3YVCLMWVKM7 Total Number of Employees 5to9 Sector Health Care and Social Assistance Menu - a LO O N N Cn a- C9 m 0 U a- J w 2 N N w i a� E: 0 a CU 0- E 0 U a� E r r Q Employer Category Packet Pg. 930 Employer Category 16.D.4.e None of these categories apply Edit Employer Category Company Addresses Physical Address 3200 Bailey Lane Ste 109 Naples, FL 34105 Mailing Address Same as Physical Address Edit Company Addresses Hiring Sites We have implemented a new policy and require more information for existing and future hiring sites. Number of Sites Edit Hiring Sites Company Access and M O U My Company is configured to: Verify Its Own Employees Memorandum of Understanding View Current MOU U.S. Department of Homeland Security U.S. Citizenship and Immigration Services Accessibility_ Plug -ins Site Map Packet Pg. 931 16.D.4.e OP4� �N � � /�USA� °s�� qND Sk� IIIIIII Y E L a LO O N N d m U d J W 2 N On V Cn N �L 1, d r Q Packet Pg. 932 16. D.4.f Form W=9 (Rev. March 2024) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Go to www.irs.gov/ForrnW9 for instructions and the latest Information. Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Font, below. Give form to the requester. Do not send to the IRS. Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded entity's name on line 2.) 2 Business name/disregarded entity name, if different from above. 3a Check the appropriate box for federal tax classification of the entity/individual whose name Is entered on line 1. Check only one of the following seven boxes. ❑ Individual/sole proprietor ❑ C corporation ❑ S corporation ❑ Partnership ❑ Trust/estate ❑ U.C. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) . . . . Note: Check the 'LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner. Other (See instructions) Non-profit corporation exempt under IRS code 501(c)3 3b If on line 3a you checked "Partnership" or'Trust/estate." or checked `LLC' and entered 'P' as its tax classification, and you are providing this forth to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions . . . . . . . . . ❑ Address (number, street, and apt. or suite no.). See Instructions. 6 City, state, and ZIP code 7 Ust account number(s) here (optional) 4 Exemptions (codes apply only to certain entities, not Individuals; see instructions on page 3): Exempt payee code (if any) Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (iany) (Applies to accounts maintained outside the United States.) Requester's name and address (optional) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid ( Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, for a — M — resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a or 77N, later. Employer Identification number Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter. 3 S — 3 6 9 5 9 2 8 Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer Identification number (or 1 am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3.1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA oode(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Cert)ftcatlon Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later. General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.1rs.gov/FormW9. What's New Line 3a has been modified to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax classification of its owner. Otherwise, it should check the "LLC" box and enter its appropriate tax classification. New line 3b has been added to this form. A flow -through entity is required to complete this line to indicate that it has direct or Indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another flow -through entity in which it has an ownership interest. This change is intended to provide a flow -through entity with Information regarding the status of its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065). Purpose of Form An individual or entity (Forth W-9 requester) who is required to file an information return with the IRS is giving you this form because they Cat. No. 10231X Form W-9 (Rev. 3-2024) Packet Pg. 933 16.D.4.g Search > Account Summary. > Bill Details Business Tax Account #171504 HOUSING DEVELOPMENT CORPORATION OF SW FL Current owner: Doing business as: Current business address: Current business phone: HOUSING DEVELOPMENT CORPORATIO HELP 3200 BAILEY LN #109 434-2397 More Details 2024 Details Account number: 171504 Mailing address: HOUSING DEVELOPMENT CORPORATION OF SW FL Business start date: 12/01/2017 3200 BAILEY LN #109 NAPLES, FL 34105 Physical business location: Collier County Owner(s): HOUSING DEVELOPMENTCORPORATIO Business address: HOUSING DEVELOPMENT CORPORATION OF SW FL 3200 BAILEY LN #109 3200 BAILEY LN #109 NAPLES, FL 3414105 Business phone: 434-2397 RECEIPTS AND OCCUPATIONS RECEIPT 171504 PROFESSIONAL 10/01/2023 - $0.00 NON-PROFIT ORGANIZATION 09/30/2024 Total Amount Due: $0. Confirm Business Status c E N O N u) D. m 0 U a. U1 2 N v rn N PacketPg. 934 16.D.4.h Search > Account Summary. > Bill Details Business Tax Account #171504 HOUSING DEVELOPMENT CORPORATION OF SW FL Current owner: Doing business as: Current business address: Current business phone: HOUSING DEVELOPMENT CORPORATIO HELP 3200 BAILEY LN #109 434-2397 More Details 2025 Details Account number: 171504 Mailing address: HOUSING DEVELOPMENT CORPORATION OF SW FL Business start date: 12/01/2017 3200 BAILEY LN #109 NAPLES, FL 34105 Physical business location: Collier County Owner(s): HOUSING DEVELOPMENTCORPORATIO Business address: HOUSING DEVELOPMENT CORPORATION OF SW FL 3200 BAILEY LN #109 3200 BAILEY LN #109 NAPLES, FL 3414105 Business phone: 434-2397 RECEIPTS AND OCCUPATIONS RECEIPT 171504 PROFESSIONAL 10/01/2024- $0.00 NON-PROFIT ORGANIZATION 09/30/2025 Total Amount Due: $0. Confirm Business Status c E N O N u) D. m 0 U a. U1 2 N v rn N PacketPg.935 HOUSDEV-01 16.D.4A '4coRo CERTIFICATE OF LIABILITY INSURANCE FI(M MIDD/YYYY) /19/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI: CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE! BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement or this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (800) 845-8437 (A/C, No): Acrisure Southeast Partners Insurance Services, LLC 1317 Citizens Blvd Leesburg, FL 34748 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Sentinel Insurance Company, Ltd 11000 INSURED INSURER B : Associated Industries Insurance Company, Inc. 23140 Housing Development Corp 13056 INSURER C : RLI Insurance Company of Florida, Inc. N 0 3200 Bailey Lane, Ste. 109 Travelers Casualty and Surety Company of America INSURER D : Y Y p Y 31194 E INSURER E : Naples, FL 34105 y L INSURER F : C111 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI! CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR W D POLICY NUMBER POLICY EFF MM DD YYYY POLICY EXP MM DD YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,1 CLAIMS -MADE X OCCUR X 21SBMBW5724 8/18/2024 8/18/2025 DAMAGE TO RENTED PREMISES Ea occurrence 1,000,1 $ MED EXP (Any oneperson) $ 10" PERSONAL & ADV INJURY $ 1,000,1 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,1 X POLICY El JECOT- LOC PRODUCTS - COMP/OP AGG $ 2,00011 $ OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1 000,1 $ BODILY INJURY Perperson) $ ANY AUTO 21SBMBW5724 8/18/2024 8/18/2025 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident) ent $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B W KERS COMPENSATION ANDEMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A AWC1204527 3/22/2024 3/22/2025 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,1 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,1 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,1 $ C Professional Liab RTP0042836 3/22/2024 3/22/2025 Ded: 1,000 500,1 D Crime 107163108 10/7/2023 10/7/2024 Ded: 1,000 1,000,1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Collier County Board of County Commissioners is included as Additional Insured for any and all work performed in Collier County on a primary and noncontributory basis with regards to General Liability only as required by written contract per form SS008 0405, includes ongoing and completed operatio Waiver of Subrogation in favor of Additional Insured. Collier County Board of County Commissioners 3295 Tamiami Trail E. Naples, FL 34112 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED It ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Q 0 N N to d 0 tYi V a J W N a) lA N ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION The ACORD name and logo are registered marks of ACORD Packet Pg. 936