Backup Documents 10/11/2016 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTINGE Q
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT Tg.
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Ana Diaz Community&Human
Services
2. Jennifer Belpedio County Attorney Office
Ia \
3. BCC Office Board of County
Commissioners V VS/ VAN,3\4.0
4. Minutes and Records Clerk of Court's Office
tOf(31cb y=z` m
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Jody Paley Phone Number 252-2903
Contact/ Department
Agenda Date Item was October 11,2016 Agenda Item Number 16.D.4
Approved by the BCC
Type of Document Landlord Agreements ' Number of Original 1
Attached C a C76LAkl„,sDocuments Attached
PO number or account \
number if document is NA
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? ,r.� O d�x JP
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JP
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JP
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JP
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on and all changes made during the
meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the ^
BCC,all changes directed by the BCC have been made, and the document is ready for the (_�J(�J�
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16 04
MEMORANDUM
Date: October 14, 2016
To: Jody Paley, Grants Coordinator
Community & Human Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Landlord Payment Agreement between Collier County
and C & C Building Company
Attached, please a copy of the agreement referenced above, (Item #16D4) approved
by the Board of County Commissioners on Tuesday, October 11, 2016.
The original agreement will be held in the Minutes and Records Department for the
Board's Official Record.
If you have any questions, please feel free to call me at 252-8406.
Thank you
Attachment
1 6 0 4
EMERGENCY SOLUTIONS GRANT
LANDLORD PAYMENT AGREEMENT
FOR TENANT BASED RENTAL ASSISTANCE
THIS AGREEMENT is entered into between Collier County Board of County Commissioners,
hereinafter referred to as the "agency," C & C Building Co. whose address is 24644 Sargent
Avenue, Southfield, MI 48033
The undersigned landlord hereby agrees to the following conditions in order to receive landlord
payments from the agency under the Emergency Solutions Grant Program (ESG):
1. This agreement shall begin on September 27, 2016 and shall end upon 30-days written
notification from either party to the other, or if funding for this program is no longer
available.
2. The agency agrees to provide the landlord with a list of names and contact information for all
agency personnel authorized to commit ESG funds. The landlord will only accept payment
commitment from authorized agency personnel. Changes (addition/deletions) to the
authorized personnel list must be approved in writing by an authorized agency representative.
3. The landlord agrees to provide agency with contact information for authorized CHS
representative to resolve a crisis and/or apply benefit commitment on the client's behalf.
4. The landlord agrees to provide agency with copy of all leases and modifications or
amendments for each eligible ESG program participant.
5. The agency agrees to provide payments directly to the landlord on behalf of the eligible ESG
program participant and as long as the grantor agency and/or regulation does not prohibit
payment.
6. The landlord assures that no household receiving ESG assistance will be treated adversely
because of such assistance under applicable provisions of federal, state or local regulatory
requirements. During the term of this agreement, landlord agrees to give the agency a copy of
any notice to the program participant to vacate the housing unit, or complaint used under
state or local law to commence an eviction action against the program participant.
7. The landlord assures that eligible households on whose behalf ESG assistance is received
will not be discriminated against.
8. The landlord understand that only eligible activities listed under 24 CFR 576.106, Short-term
and medium-term rental assistance, are to be paid with ESG funds.
9. The landlord understand that only costs of Short-term and medium-term rental assistance in
accordance with the terms of the ESG program are allowed. No charges that result from
illegal activities such as bad checks or meter tampering will be paid with ESG funds.
Page 1 of 3
(.4"\
1Ôt 'u4
10. The landlord understand that the ESG benefit amount must pay for the complete charges
owed by the ESG program participant and that acceptance of ESG benefit will be deemed as
Landlord's acknowledgement and acceptance has become current on any and all payments
due to landlord as a result of the ESG payment.
11. The landlord agrees to assist the agency in verifying the ESG program participant's
information and to make timely commitments to resolve any crisis situation. Subject to the
landlord's privacy requirements, the landlord agrees to provide the agency with the following
detailed ESG program participant information: (1) current amount owed (broken down by
month) (2) due date/eviction dates in formal eviction notice / 3-day notice and (3) amount
necessary to resolve the situation.
12. In accordance with the Florida Local Government Prompt Payment Act, the agency agrees to
provide payment to the landlord as follows:
(a) Rental Arrears, Application Fees and/or Deposits: will be dispersed by the agency
within 60 days from the date of the agency's approval of the program participant's
eligibility if the rental assistance is a valid ESG program expenditure.
(b) Ongoing rental assistance: will be disbursed by the agency for eligible ESG recipients
in accordance with the rental agreement as issued by the landlord on behalf of the
program participant under the same terms and conditions (i.e., same payment due date,
grace period, and late penalty requirements).
(c) Payments beyond 60 days will require interest to be paid from non-ESG funds.
(d) Agency's promise to pay can only be issued after ESG participant has been certified as
Eligible under the ESG program.
13. This Landlord Agreement will be signed by agency, and landlord's authorized representative.
Documentation authorizing authority must be provided from landlord.
14. Checks issued by Agency shall be payable to C & C Building Co. and mailed to: C & C
Building Co. c/o Sunderland Construction Company, Inc., 8380 Excalibur Circle, Apt. H-8,
Naples, FL 34108.
15. If an ESG payment to the landlord cannot be applied to a ESG program participant's account,
the funds will be returned to the agency.
16. The landlord, with the exception of municipal providers, must be in "active" status with the
State of Florida: http://sunbiz.org/search.html. The landlord's name must also be verified
against the System for Award Management website at http://www.sam.gov. The agency
agrees to maintain documentation of verification that the business name of the landlord on
this agreement is the same as the legal business name on the State of Florida System for
Award Management website.
Page 2 of 3
d
GQ I
16D4
17. Agency does not assume any responsibility for, or liability to, any person injured as a result
of landlord's action or failure to act in connection with the implementation of this agreement
or as a result of any other or failure to act by the landlord.
18. Landlord is not the agent of agency and this agreement does not create any relationship
between agency and any lender to landlord or suppliers, employees, contractors or
subcontractors used by landlord in connection with this agreement.
19. Nothing in this agreement will be construed as creating any right of a program participant or
a third-party to enforce any provision of this agreement or to assess any claim against
agency, or landlord under this Rental Assistance Agreement.
IN WITNESS THEREOF, the parties hereto have caused this agreement to be executed by their
undersigned officials as duly authorized.
AGENCY LANDLORD
Collier County Government C &C Building Co.
Community and Human Services 24644 Sargent Avenue
3339 Tamiami Trail East, Su 211 Southfield., MI 48033
Naples, F- 34112
BY: t?'Yhe BY: fi
Don a Fiala, Chairman Costa J Char , President
t
Date: / 1Date: /0 3 - 20/6
Approved as to form and legality
DINtdkrt. BkOCK, Clerk
W) Assistant County Attom
Attest as to Chairman's C) �\
signature only.
{tem#
Agendani-1,666
Date
Date
Page 3 of 3 Rid r
.11
i eptk
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D )�
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO `�F
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Michelle Rubbo Community &Human
Services
2. Emily Pepin ,r,v,►-k County Attorney Office
3. BCC Office Board of County "C)Fb�
Commissioners '(, / kc. L\l h
4. Minutes and Records Clerk of Court's Office R fSqQ
in
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Jody Paley Phone Number 252-2903
Contact/ Department
Agenda Date Item was October 11,2016 Agenda Item Number 16.D /
Approved by the BCC C�
\/
Type of Document Landlord Agreementsmoo+ C +C Number of Original /1
Attached Documents Attached `t'
PO number or account
number if document is NA
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? SA,A04 e 34,-
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JP
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JP
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JP
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on_and all changes made during the
meeting have been incorporated in the attached document. The County Attorney's >
Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for t -
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1604
MEMORANDUM
Date: October 14, 2016
To: Jody Paley, Grants Coordinator
Community & Human Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Landlord Payment Agreements between Collier County
and Robert Flick Rev Trust, David Lackey, Bruce A. Passarelli
and Roger J. Marco/VR Raceina Rev Living Trust for
participation in the Rapid Re-Housing and Homelessness
Prevention Program
Attached, please a copies of the agreements referenced above, (Item #16D4) approved
by the Board of County Commissioners on Tuesday, October 11, 2016.
The original agreements will be held in the Minutes and Records Department for
the Board's Official Record.
If you have any questions, please feel free to call me at 252-8406.
Thank you
Attachments
1604
EMERGENCY SOLUTIONS GRANT
LANDLORD PAYMENT AGREEMENT
FOR TENANT BASED RENTAL ASSISTANCE
THIS AGREEMENT is entered into between Collier County Board of County Commissioners,
hereinafter referred to as the "agency", Bruce A. Passarelli, 30 Upper Sheep Pasture Rd.
Setauket,NY 11733-1749, 1-631-889-2202, hereinafter referred to as the "landlord".
The undersigned landlord hereby agrees to the following conditions in order to receive landlord
payments from the agency under the Emergency Solutions Grant Program(ESG):
1. This agreement shall begin on September 12, 2016 and shall end upon 30-days written
notification from either party to the other, or if funding for this program is no longer
available.
2. The agency agrees to provide the landlord with a list of names and contact information for all
agency personnel authorized to commit ESG funds. The landlord will only accept payment
commitment from authorized agency personnel. Changes (addition/deletions) to the
authorized personnel list must be approved in writing by an authorized agency representative.
3. The landlord agrees to provide agency with contact information for authorized CHS
representative to resolve a crisis and/or apply benefit commitment on the client's behalf.
4. The landlord agrees to provide agency with copy of all leases and modifications or
amendments for each eligible ESG program participant.
5. The agency agrees to provide payments directly to the landlord on behalf of the eligible ESG
program participant and as long as the grantor agency and/or regulation does not prohibit
payment.
6. The landlord assures that no household receiving ESG assistance will be treated adversely
because of such assistance under applicable provisions of federal, state or local regulatory
requirements. During the term of this agreement, landlord agrees to give the agency a copy of
any notice to the program participant to vacate the housing unit, or complaint used under
state or local law to commence an eviction action against the program participant.
7. The landlord assures that eligible households on whose behalf ESG assistance is received
will not be discriminated against.
8. The landlord understand that only eligible activities listed under 24 CFR 576.106, Short-term
and medium-term rental assistance, are to be paid with ESG funds.
9. The landlord understand that only costs of Short-term and medium-term rental assistance in
accordance with the terms of the ESG program are allowed. No charges that result from
illegal activities such as bad checks or meter tampering will be paid with ESG funds.
10. The landlord understand that the ESG benefit amount must pay for the complete charges
owed by the ESG program participant and that acceptance of ESG benefit will be deemed as
Page 1of3
0
1604
Landlord's acknowledgement and acceptance has become current on any and all payments
due to landlord as a result of the ESG payment.
11. The landlord agrees to assist the agency in verifying the ESG program participant's
information and to make timely commitments to resolve any crisis situation. Subject to the
landlord's privacy requirements, the landlord agrees to provide the agency with the following
detailed ESG program participant information: (1) current amount owed (broken down by
month) (2) due date/eviction dates in formal eviction notice / 3-day notice and (3) amount
necessary to resolve the situation.
12. In accordance with the Florida Local Government Prompt Payment Act, the agency agrees to
provide payment to the landlord as follows:
(a) Rental Arrears, Application Fees and/or Deposits: will be dispersed by the agency
within 60 days from the date of the agency's approval of the program participant's
eligibility if the rental assistance is a valid ESG program expenditure.
(b) Ongoing rental assistance: will be disbursed by the agency for eligible ESG recipients
in accordance with the rental agreement as issued by the landlord on behalf of the
program participant under the same terms and conditions (i.e., same payment due date,
grace period, and late penalty requirements).
(c) Payments beyond 60 days will require interest to be paid from non-ESG funds.
(d) Agency's promise to pay can only be issued after ESG participant has been certified as
Eligible under the ESG program.
13. This Landlord Agreement will be signed by agency, and landlord's authorized representative.
Documentation authorizing authority must be provided from landlord.
14. If an ESG payment to the landlord cannot be applied to a ESG program participant's account,
the funds will be returned to the agency.
15. The landlord, with the exception of municipal providers, must be in "active" status with the
State of Florida: http://sunbiz.org/search.html. The landlord's name must also be verified
against the System for Award Management website at http://www.sam.gov. The agency
agrees to maintain documentation of verification that the business name of the landlord on
this agreement is the same as the legal business name on the State of Florida System for
Award Management website.
16. Agency does not assume any responsibility for, or liability to, any person injured as a result
of landlord's action or failure to act in connection with the implementation of this agreement
or as a result of any other or failure to act by the landlord.
Page 2 of 3
O
1 6 D LI
17. Landlord is not the agent of agency and this agreement does not create any relationship
between agency and any lender to landlord or suppliers, employees, contractors or
subcontractors used by landlord in connection with this agreement.
18. Nothing in this agreement will be construed as creating any right of a program participant or
a third-party to enforce any provision of this agreement or to assess any claim against
agency, or landlord under this Rental Assistance Agreement.
IN WITNESS THEREOF, the parties hereto have caused this agreement to be executed by their
undersigned officials as duly authorized.
AGENCY LANDLORD
Collier County Government Bruce A. Passarelli
Community and Human Services 30 Upper Sheep Pasture Rd.
3339 Tamiami Trail East, Su 211 Setauket,NY 11733-1749
Naples, F 34112
BY: Y:
Donna Fiala, Chairman B 1'e '�relli
Date:
\O \ Date: ( 6 ( _
ATTEST: Approved as to form and legality
DWIGHT E. B,1OCKA Clerk
K: ', , ,_.1.0,.,0 "C3 - Assistant County Atti�ri ' i '
Attest as •n's � 1 j,
signature,onlY.,
Item# !_1. -_
e,
Agenda b_tt r ll le
Date
Date ito
ecd\---
t
r
Page 3 of 3 Depu CI-
�4
G
16D4
Form W-9 Request for Taxpayer Give Form to the
(Rev.December 2014) requester.Do not
Department of the Treasury Identification Number and Certification send to the IRS.
Internal Revenue Service
1 Name4as shown on your income tax return).Name' required on this line;do not leave thi line blank.
�–(...CCCI n _S SA - f/
csi 2 Business name/disregarded entity name,if different from above
v
rn
c
°' 3 Ch3g.irappropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to
certain entities,not individuals;see
HIndividual/sole proprietor or ❑ C Corporation 0 S Corporation ❑ Partnership 0 Trust estate instructions on page 3):
d c single-member LLC
d p Exempt payee code(if any)
4"T, ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)►
o 2 Note. For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting
the tax classification of the single-member owner. code(if any)
a -v ❑Other(see instructions)I. (Applies to accounts maintained outside the U.S.)
F. 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional)
3 0 – m-�- S(lac_( As ( rA R 4
CO 6 City,state,afid'ZIP code
co �c �c, . z-1 ii . • x173 - �( 1
7 List account number(s)here(optional)
Part I Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid I Social security number
backup withholding.For individuals,this is generally your social security number(SSN).However,for a
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other t�� L., �- -millri
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
TIN on page 3. or
Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number
guidelines on whose number to enter.
Part II Certification
Under penalties of perjury,I certify that:
1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2. I 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. I am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. '
Certification 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 retum.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 idends,you are not required to sign the certification,but you must provide your correct TIN.See the
instructions on page 3. �%
Sign US.perSignature ofZia
8 ( / / I L
Here U.S.person Date 1. /
General lr>Istructio •Form 1098(home mortgage interest),1098-E(student loan interest),1098-T
(tuition)
Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt)
Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property)
as legislation enacted after we release it)is at www.irs.gov/fw9.
Use Form W-9 only if you are a U.S.person(including a resident alien),to
Purpose of Form provide your correct TIN.
An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject
return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2.
which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you:
number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number
identification number(EIN),to report on an information return the amount paid to to be issued),
you,or other amount reportable on an information return.Examples of information
returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or
•Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If
•Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of
any partnership income from a U.S.trade or business is not subject to the
•Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and
•Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are
brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on
•Form 1099-S(proceeds from real estate transactions) page 2 for further information.
•Form 1099-K(merchant card and third party network transactions)
Cat.No.10231X Form W-9(Rev.12-2014)
16fl4
EMERGENCY SOLUTIONS GRANT
LANDLORD PAYMENT AGREEMENT
FOR TENANT BASED RENTAL ASSISTANCE
THIS AGREEMENT is entered into between Collier County Board of County Commissioners,
hereinafter referred to as the "agency" and Robert Flick Rev Trust, 1278 Highland Drive,
Naples, FL 34103 hereinafter referred to as the "landlord".
The undersigned landlord hereby agrees to the following conditions in order to receive landlord
payments from the agency under the Emergency Solutions Grant Program (ESG):
1. This agreement shall begin on August 23, 2016 and shall end upon 30-days written
notification from either party to the other, or if funding for this program is no longer
available.
2. The agency agrees to provide the landlord with a list of names and contact information for all
agency personnel authorized to commit ESG funds. The landlord will only accept payment
commitment from authorized agency personnel. Changes (addition/deletions) to the
authorized personnel list must be approved in writing by an authorized agency representative.
3. The landlord agrees to provide agency with contact information for authorized CHS
representative to resolve a crisis and/or apply benefit commitment on the client's behalf.
4. The landlord agrees to provide agency with copy of all leases and modifications or
amendments for each eligible ESG program participant.
5. The agency agrees to provide payments directly to the landlord on behalf of the eligible ESG
program participant and as long as the grantor agency and/or regulation does not prohibit
payment.
6. The landlord assures that no household receiving ESG assistance will be treated adversely
because of such assistance under applicable provisions of federal, state or local regulatory
requirements. During the term of this agreement, landlord agrees to give the agency a copy of
any notice to the program participant to vacate the housing unit, or complaint used under
state or local law to commence an eviction action against the program participant.
7. The landlord assures that eligible households on whose behalf ESG assistance is received
will not be discriminated against.
8. The landlord understand that only eligible activities listed under 24 CFR 576.106, Short-term
and medium-term rental assistance, are to be paid with ESG funds.
9. The landlord understand that only costs of Short-term and medium-term rental assistance in
accordance with the terms of the ESG program are allowed. No charges that result from
illegal activities such as bad checks or meter tampering will be paid with ESG funds.
10. The landlord understand that the ESG benefit amount must pay for the complete charges
owed by the ESG program participant and that acceptance of ESG benefit will be deemed as
Page 1 of 3
1604
Landlord's acknowledgement and acceptance has become current on any and all payments
due to landlord as a result of the ESG payment.
11. The landlord agrees to assist the agency in verifying the ESG program participant's
information and to make timely commitments to resolve any crisis situation. Subject to the
landlord's privacy requirements, the landlord agrees to provide the agency with the following
detailed ESG program participant information: (1) current amount owed (broken down by
month) (2) due date/eviction dates in formal eviction notice / 3-day notice and (3) amount
necessary to resolve the situation.
12. In accordance with the Florida Local Government Prompt Payment Act, the agency agrees to
provide payment to the landlord as follows:
(a) Rental Arrears, Application Fees and/or Deposits: will be dispersed by the agency
within 60 days from the date of the agency's approval of the program participant's
eligibility if the rental assistance is a valid ESG program expenditure.
(b) Ongoing rental assistance: will be disbursed by the agency for eligible ESG recipients
in accordance with the rental agreement as issued by the landlord on behalf of the
program participant under the same terms and conditions (i.e., same payment due date,
grace period, and late penalty requirements).
(c) Payments beyond 60 days will require interest to be paid from non-ESG funds.
(d) Agency's promise to pay can only be issued after ESG participant has been certified as
Eligible under the ESG program.
13. This Landlord Agreement will be signed by agency, and landlord's authorized representative.
Documentation authorizing authority must be provided from landlord.
14. If an ESG payment to the landlord cannot be applied to a ESG program participant's account,
the funds will be returned to the agency.
15. The landlord, with the exception of municipal providers, must be in "active" status with the
State of Florida: http://sunbiz.org/search.html. The landlord's name must also be verified
against the System for Award Management website at http://www.sam.gov. The agency
agrees to maintain documentation of verification that the business name of the landlord on
this agreement is the same as the legal business name on the State of Florida System for
Award Management website.
16. Agency does not assume any responsibility for, or liability to, any person injured as a result
of landlord's action or failure to act in connection with the implementation of this agreement
or as a result of any other or failure to act by the landlord.
17. Landlord is not the agent of agency and this agreement does not create any relationship
between agency and any lender to landlord or suppliers, employees, contractors or
subcontractors used by landlord in connection with this agreement.
Page 2 of 3
16 04
18. Nothing in this agreement will be construed as creating any right of a program participant or
a third-party to enforce any provision of this agreement or to assess any claim against
agency, or landlord under this Rental Assistance Agreement.
IN WITNESS THEREOF, the parties hereto have caused this agreement to be executed by their
undersigned officials as duly authorized.
AGENCY LANDLORD
Collier County Government Robert Flick Rev Trust
Community and Human Services 1278 Highland Drive
3339 Tamiami Trail East, Su 211 Florida City, FL 34103
Naples, F 34112
BY: BY: , // a. , Rzo:
Donna Fiala Authorized Person to SignL
Chairman
Date: \O \1 X \\ LP Date: fr (,/ 6 (/ V l
A TTU:
D'„V,CliT E.EReCK CLERK
`iie t�'��•NIP Approved as to form and legality
Depu di
Attest as to Chairman's Assistant County At ey
signature only. 55
cac \\w
q\�
Page 3 of 3
1 6 0 4
EMERGENCY SOLUTIONS GRANT
LANDLORD PAYMENT AGREEMENT
FOR TENANT BASED RENTAL ASSISTANCE
THIS AGREEMENT is entered into between Collier County Board of County Commissioners,
hereinafter referred to as the "agency", David Lackey. 313 185th St., Star Prairie, WI, 54026.
612-805-8137 hereinafter referred to as the"landlord".
The undersigned landlord hereby agrees to the following conditions in order to receive landlord
payments from the agency under the Emergency Solutions Grant Program (ESG):
1. This agreement shall begin on September 27. 2016 and shall end upon 30-days written
notification from either party to the other, or if funding for this program is no longer
available.
2. The agency agrees to provide the landlord with a list of names and contact information for all
agency personnel authorized to commit ESG funds. The landlord will only accept payment
commitment from authorized agency personnel. Changes (addition/deletions) to the
authorized personnel list must be approved in writing by an authorized agency representative.
3, The landlord agrees to provide agency with contact information for authorized CHS
representative to resolve a crisis and/or apply benefit commitment on the client's behalf
4. The landlord agrees to provide agency with copy of all leases and modifications or
amendments for each eligible ESG program participant.
5. The agency agrees to provide payments directly to the landlord on behalf of the eligible ESG
program participant and as long as the grantor agency and/or regulation does not prohibit
payment.
6. The landlord assures that no household receiving ESG assistance will be treated adversely
because of such assistance under applicable provisions of federal, state or local regulatory
requirements. During the term of this agreement, landlord agrees to give the agency a copy of
any notice to the program participant to vacate the housing unit, or complaint used under
state or local law to commence an eviction action against the program participant.
7. The landlord assures that eligible households on whose behalf ESG assistance is received
will not be discriminated against.
8. The landlord understand that only eligible activities listed under 24 CFR 576.106, Short-term
and medium-term rental assistance, are to be paid with ESG funds.
9. The landlord understand that only costs of Short-term and medium-term rental assistance in
accordance with the terms of the ESG program are allowed. No charges that result from
illegal activities such as bad checks or meter tampering will be paid with ESG funds.
10. The landlord understand that the ESG benefit amount must pay for the complete charges
owed by the ESG program participant and that acceptance of ESG benefit will be deemed as
Page 1 of 3
1604
Landlord's acknowledgement and acceptance has become current on any and all payments
due to landlord as a result of the ESG payment.
11. The landlord agrees to assist the agency in verifying the ESG program participant's
information and to make timely commitments to resolve any crisis situation. Subject to the
landlord"s privacy requirements, the landlord agrees to provide the agency with the following
detailed ESG program participant information: (I) current amount owed (broken down by
month) (2) due date/eviction dates in formal eviction notice / 3-day notice and (3) amount
necessary to resolve the situation.
12. In accordance with the Florida Local Government Prompt Payment Act, the agency agrees to
provide payment to the landlord as follows:
(a) Rental Arrears, Application Fees and/or Deposits: will be dispersed by the agency
within 60 days from the date of the agency's approval of the program participant's
eligibility if the rental assistance is a valid ESG program expenditure.
(b) Ongoing rental assistance: will be disbursed by the agency for eligible ESG recipients
in accordance with the rental agreement as issued by the landlord on behalf of the
program participant under the same terms and conditions(i.e., same payment due date,
grace period,and late penalty requirements).
(c) Payments beyond 60 days will require interest to be paid from non-ESG funds.
(d) Agency's promise to pay can only be issued after ESG participant has been certified as
Eligible under the ESG program.
13. This Landlord Agreement will be signed by agency, and landlord's authorized representative.
Documentation authorizing authority must be provided from landlord.
14. If an ESG payment to the landlord cannot be applied to a ESG program participant's account.
the funds will be returned to the agency.
15. The landlord, with the exception of municipal providers, must be in "active" status with the
State of Florida: http:,,sunhii ' y irch ht;nI. The landlord's name must also be verified
against the System for Award `lanagement website at ‘\.sam.coy. The agency
agrees to maintain documentation of verification that the business name of the landlord on
this agreement is the same as the legal business name on the State of Florida System for
Award Management website.
16. Agency does not assume any responsibility for, or liability to, any person injured as a result
of landlord's action or failure to act in connection with the implementation of this agreement
or as a result of any other or failure to act by the landlord.
Page 2 of 3
16fl4 4.4
17. Landlord is not the agent of agency and this agreement does not create any relationship
between agency and any lender to landlord or suppliers, employees, contractors or
subcontractors used by landlord in connection with this agreement.
18. Nothing in this agreement will be construed as creating any right of a program participant or
a third-party to enforce any provision of this agreement or to assess any claim against
agency, or landlord under this Rental Assistance Agreement.
IN WITNESS THEREOF, the parties hereto have caused this agreement to be executed by their
undersigned officials as duly authorized.
AGENCY LANDLORD
Collier County Government David Lackey
Community and Human Services 313 185th St.
3339 T iami Trail East, Su 211 Star Prairie, WI 54026
Naple L 34112
BY:
O•nna Fiala,Chairman David Lackey V
Date: ‘c7 I ' V Date:
ATTEST;
DWIGHT E.BROCK,CLERK
Approved as to form and legality
VA A t ' bi4o.,.... _ C .
Qeputy
Assistant County A �rney (�
Attest as to Chairman's 2 -��\L!
slgnatI e nly, o\\
Page 3 of 3
.. , .
1604 ..,d
Form W-9 Request for Taxpayer Give Form to the
(Rev. 2014) requester.Do not
(Rev.DepaDecember
ment of 4Identification Number and Certification send to the IRS.
Internal Revenue Service
1 Name(as shown on your,income tax return).Name is required on tie line;do not leave this line blank
\___.) * Cr. C._.\4...Q...
N 2 Business name/disregarded entity name.if different from above
a 3 k appropriate check for federal tax classification; only one of the following seven boxes: 4 Exemptions(codes apply only to
O Individual/sole proprietor or IDC Corporation ❑S Corporation ❑ Partnership ❑ Trust estate instructions on page 3):
I
single-member LLC
4
yY El Limited liability company.Enter the tax classification(C=C corporation.S=S corporation.P=partnership)S. Exempt payee code(if any)
b Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting
M the tax classification of the single-member owner. code(if arty)
E C Other(see instructions) woo..•>• i+mortared anode mee U S.i
tstreet, suite 5 Address(number. et.and apt.or no.) ' Requester's name and address(optional)
6 City,state,and ZIP 1
0.
•
7 List account numbers)here(optional)
Part I Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid 1 Social security number
backup withholding.For individuals,this is generally your social security number(SSN).However,for a i MIMI IIIII lipilirli-
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
TIN on page 3. •
Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for I Employer bantificatO^number
guidelines on whose number to enter.
Part II Certification
Under penalties of perjury,I certify that:
1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2. I 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. I am a U.S.citizen or other U.S.person(defined below):and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification 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 on page 3.
Sign Signature of .
Here u.s.person I. `-_ -----2" bateiv a
\ \\C
General Instructions •Form 1098(home mortgage interest).1098 (st dent ban interest).1096-T
(ttitiorn)
Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt)
Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property)
as legislation enacted after we release i)is at www.irs.gov/tw9.
Use Form W-9 only if you are a U.S.person(including a resident alien),to
Purpose of Form provide your correct TIN.
An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subiect
return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding2 on page 2.
which may be your social security number(SSN),individual taxpayer identification By signing the filled-out forth,you:
number(tTIN),adoption taxpayer identification number(ATIN).or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number
identification number(EIN),to report on an information return the amount paid to
you,or other amount reportable on an information return Examples of information to be issued),
returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or
•Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If
•Form 1099-DIV(dividends.including those from stocks or mutual funds) applicable.you are also certifying that as a U.Syour person, allocable share of
any partnership income from a U.S.trade or business is not subject to the
•Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and
•Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are
brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on
•Form 1099-S(proceeds from real estate transactions) page 2 for further information.
•Form 1099-K(merchant card and third party network transactions)
Cat.No.10231X Form W-9(Rev.12-2014)
1604
EMERGENCY SOLUTIONS GRANT
LANDLORD PAYMENT AGREEMENT
FOR TENANT BASED RENTAL ASSISTANCE
THIS AGREEMENT is entered into between Collier County Board of County Commissioners,
hereinafter referred to as the "agency", Roger J Marco/VR Raceina Rev Living Trust, 7699
Hernando Ct.,Naples, FL 34114 and hereinafter referred to as the "landlord".
The undersigned landlord hereby agrees to the following conditions in order to receive landlord
payments from the agency under the Emergency Solutions Grant Program (ESG):
1. This agreement shall begin on September 27, 2016 and shall end upon 30-days written
notification from either party to the other, or if funding for this program is no longer
available.
2. The agency agrees to provide the landlord with a list of names and contact information for all
agency personnel authorized to commit ESG funds. The landlord will only accept payment
commitment from authorized agency personnel. Changes (addition/deletions) to the
authorized personnel list must be approved in writing by an authorized agency representative.
3. The landlord agrees to provide agency with contact information for authorized CHS
representative to resolve a crisis and/or apply benefit commitment on the client's behalf
4. The landlord agrees to provide agency with copy of all leases and modifications or
amendments for each eligible ESG program participant.
5. The agency agrees to provide payments directly to the landlord on behalf of the eligible ESG
program participant and as long as the grantor agency and/or regulation does not prohibit
payment.
6. The landlord assures that no household receiving ESG assistance will be treated adversely
because of such assistance under applicable provisions of federal, state or local regulatory
requirements. During the term of this agreement, landlord agrees to give the agency a copy of
any notice to the program participant to vacate the housing unit, or complaint used under
state or local law to commence an eviction action against the program participant.
7. The landlord assures that eligible households on whose behalf ESG assistance is received
will not be discriminated against.
8. The landlord understands that only eligible activities listed under 24 CFR 576.106, Short-
term and medium-term rental assistance, are to be paid with ESG funds.
9. The landlord understands that only costs of Short-term and medium-term rental assistance in
accordance with the terms of the ESG program are allowed. No charges that result from
illegal activities such as bad checks or meter tampering will be paid with ESG funds.
10. The landlord understands that the ESG benefit amount must pay for the complete charges
owed by the ESG program participant and that acceptance of ESG benefit will be deemed as
Page 1 of 3
CAO
1604
Landlord's acknowledgement and acceptance has become current on any and all payments
due to landlord as a result of the ESG payment.
11. The landlord agrees to assist the agency in verifying the ESG program participant's
information and to make timely commitments to resolve any crisis situation. Subject to the
landlord's privacy requirements, the landlord agrees to provide the agency with the following
detailed ESG program participant information: (1) current amount owed (broken down by
month) (2) due date/eviction dates in formal eviction notice / 3-day notice and (3) amount
necessary to resolve the situation.
12. In accordance with the Florida Local Government Prompt Payment Act, the agency agrees to
provide payment to the landlord as follows:
(a) Rental Arrears,Application Fees and/or Deposits:will be dispersed by the agency
within 60 days from the date of the agency's approval of the program participant's
eligibility if the rental assistance is a valid ESG program expenditure.
(b) Ongoing rental assistance: will be disbursed by the agency for eligible ESG recipients
in accordance with the rental agreement as issued by the landlord on behalf of the
program participant under the same terms and conditions(i.e., same payment due date,
grace period, and late penalty requirements).
(c) Payments beyond 60 days will require interest to be paid from non-ESG funds.
(d) Agency's promise to pay can only be issued after ESG participant has been certified as
Eligible under the ESG program.
13. This Landlord Agreement will be signed by agency, and landlord's authorized representative.
Documentation authorizing authority must be provided from landlord.
14. If an ESG payment to the landlord cannot be applied to a ESG program participant's account,
the funds will be returned to the agency.
15. The landlord, with the exception of municipal providers, must be in "active" status with the
State of Florida: http://sunbiz.org/search.html. The landlord's name must also be verified
against the System for Award Management website at http://www.sam.gov. The agency
agrees to maintain documentation of verification that the business name of the landlord on
this agreement is the same as the legal business name on the State of Florida System for
Award Management website.
16. Agency does not assume any responsibility for, or liability to, any person injured as a result
of landlord's action or failure to act in connection with the implementation of this agreement
or as a result of any other or failure to act by the landlord.
Page 2 of 3
1604 1
17. Landlord is not the agent of agency and this agreement does not create any relationship
between agency and any lender to landlord or suppliers, employees, contractors or
subcontractors used by landlord in connection with this agreement.
18.Nothing in this agreement will be construed as creating any right of a program participant or
a third-party to enforce any provision of this agreement or to assess any claim against
agency, or landlord under this Rental Assistance Agreement.
IN WITNESS THEREOF, the parties hereto have caused this agreement to be executed by their
undersigned officials as duly authorized.
AGENCY LANDLORD
Collier County Government Roger J.Marco/VR Raceina Rev Living Trst
Community and Human Services 7699 Hernando Court
3339 Tamiami Trail East, Su 211 Naples, FL 34114
Naples''L 34112
BY: BY C 4od
onna Fiala, Chairman Roger J . co +�
Date: t d ' \ ' Date: 9. /6 1 '�
ATTEST:
Approved as to form and legality
DWIGHT E. aROtic Clerk
'
' Assistant County torucy
"s
Attest as to C,'
signature only.
o.Page 3 of 3
0
16 04
For, W-9 Request for Taxpayer Give Form to the
(Rev.December2014) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
N 2 Business name/disregarded entity name,if different from above
at
w
cd
a 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to
ocertain entities,not individuals;see
•'4f Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑Trust/estate instructions on page 3):
c T_single-member LLC Exempt payee code(if any)
❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)►
0Exemption from FATCA reporting
p Note.Fora single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for
c . the tax classification of the single-member owner. code Of any)
❑Other(see instructions)► (Applies to accounts maintained outside the U.S.)
E5 Address(number,street, nd apt.or suite no.) Requester's name and address(optional)
0.
L
M
6 City,state,and ZIP code
7 List account nu er(s)here(optional)
Part I Taxpayer Identification Number(TIN)
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
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other -
_ B01,
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
TIN on page 3. or
Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number
guidelines on whose number to enter.
Part II Certification
Under penalties of perjury,I certify that:
1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2. I 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. I am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification 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 on page 3.
Sign Signature of L�) /
Here U.S.perso ��' U Date I. f/ Q (/ 6
General Instructions fr •Form 1098(home mortgage interest),1098-E(student loan interest),1098-T
(tuition)
Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt)
Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property)
as legislation enacted after we release it)is at www.irs.gov/fw9.
Use Form W-9 only if you are a U.S.person(including a resident alien),to
Purpose of Form provide your correct TIN.
An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject
return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2.
which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you:
number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number
identification number(EIN),to report on an information return the amount paid to to be issued),
you,or other amount reportable on an information return.Examples of information
returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or
•Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If
•Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of
any partnership income from a U.S.trade or business is not subject to the
•Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and
•Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are
brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on
•Form 1099-S(proceeds from real estate transactions) page 2 for further information.
•Form 1099-K(merchant card and third party network transactions)
Cat.No.10231X Form W-9(Rev.12-2014)