Agenda 05/12/2009 Item #10B
Agenda 11em No, 108
May 12, 2009
Page 1 of 36
EXECUTIVE SUMMARY
Recommendation that tbe Board of County Commissioners provide staff direction on wbether to
defer impact fees for a proposed 140 unit affordable rental apartment development located in
lmmokalee, Florida.
OBJECTIVE: That the Board of County Commissioners ("BCC") provide staff direction on whether
to defer impact fees for a proposed 140 unit affordable rental apartment development located in
Immokalee, Florida,
CONSIDERATIONS: Article IV of Chapter 74 of the Code of Laws and Ordinances established a
program to defer impact fees for qualified affordable housing, A Developer is permitted to request
deferral of impact fees for affordable rental apartment dwelling units, The Ordinance allows for the
deferral of impact fees on a county-wide total of 225 rental units per fiscal year,
On April 14,2009, under public petition item 6C, Mr. Barry Goldmeier appeared before the BCC to
request a commitment to defer impact fees for a proposed 140 unit affordable rental apartment
development to be constructed in lmmokalee, Florida. Following discussion, statf was directed to
bring Mr. Goldmeier's request back at a future meeting for BCC consideration,
Mr. Barry Goldmeier is requesting a commitment to defer impact fees as part of his application for
State funding under the 2009 Univcrsal Cycle. Mr. Gold meier's application will receive additional
points in the application scoring process if it can be demonstrated that the local government will
provide a contribution to the proposed developmcnt A common method of local contribution is the
deferral or waiver of impact fees.
Section 74-401 (a)(2) of the Code of Laws and Ordinances requires an applicant seeking an affordable
housing impact fee deferral to submit an application, prior to receiving a building permit, containing
the following information:
1. The name and address of the applicant;
2. An up to date, complete legal description of the site upon which the development is proposed to
be located;
3, The maximum income level of the owner, or if the owner is a developer or builder, the income
level of the household to which the dwelling unit is to be sold or provided for occupancy;
4, The square footage and number of bedrooms in each dwelling unit of the development.
Approval of this request would be an exception to existing policy of accepting applications when all of
the above infonnation is readily available and construction is expected to commence in the near future,
This request would commit to defer impact fees and may result in other developers of affordable
housing to request a set aside of deferrals for future development
A deferral for these units today is estimated at $2,126,818.40, Please note that the actual deferral
amount cannot be calculated until issuance of a building pelmit(s),
Staff requests direction and offers the following options for consideration:
Agenda Item NO.1 OB
May 12, 2009
Page 2 of 36
Approve a Commitment to Deferral ofImpact Fees
Approval of this request will commit to the deferral of impact fees for 140 affordable rental apartment
units with a CUlTent estimated amount of $2,126,818.40, Additionally, approval would authorize the
Chairman to sign the attached 2009 Universal Cycle - Local Government Verification of Contribution
- Fee Deferral form and any other documents required by the State, subject to prior review by the
County Attorney's Office,
Decline to Commit to Deferral ofImpact Fees
Declining to commit to the deferral of impact fees at this time would not prevent Mr. Goldmeier from
seeking deferral once the proposed project is further advanced in the development stage, As is typical
of the existing program, the Developer would apply for deferral, subject to availability under the fiscal
year cap of 225 units, once pernlit number(s) were available. However, should the Board decline to
commit to the deferral of impact fees at this time, the applicant may not receive additional points in the
application scoring process for funding from Florida Housing Finance Corporation.
FISCAL IMPACT: Approval of this request would defer impact fees for 140 affordable rental
apartment units for a term of ten years. Today's estimated deferral amount is $2, 126,818.40, Prior to
executing an agreement for the deferral of impact fees, the developer would be required to provide a
security instrument acceptable to the County Attorney's Office,
GROWTH MANAGEMENT IMPACT: None,
LEGAL CONSIDERATIONS: This item has been reviewed and approved by the County Attorney's
Omee, This item is not quasi judicial, and as such ex paJie disclosure is not required, This item
requires majority vote only, This item is legally sufficient for Board approval. ~ CMG
RECOMMENDA TJON: Obtain direction from the Board of County Commissioners on whether to
defer impact fees for a proposed 140 unit affordable rental apartment development located in
Immokalee, Florida,
PREPARED BY: Frank Ramsey, Housing Manager, Housing and Human Services
Agenda 11em No.1 OB
May 12, 2009
Page 3 of 36
2009L"rVERSAL CYCLE ~ APPLICA,''H CERTffiCATIO:\' A.'iD ACKNOWLEDGnl.El\'T
The Applicant cel1ifies that the proposed Dewlopment can be completed and operating within the de\'elopment
schedule and budget submitted to the Corporation.
The Applicant acknowledges that the Corporation may conduct its 0\\11 independent re\'iew, analysis and
wlification of all infolluation contained in this Application and that any ftmding preliminarily secured by the
Applicant is expres~ly conditioned npon such verification. the ~ttttessful cmllpletion of credit lUldernTiting, all
necessaJY appro\'aIs by dIe BOaJ'd of Directors, COIporationlegal counsel Bond Connsel. if applicable, dIe Credit
Undelv.nter. and Corporation Staff.
If preliminary funding is approved, the Applicant will promptly furnish such other sUPPOl1ing infolmatioll,
dOClUllents. and fees as lllay be requested or required. The Applicant Wlderstands and agrees that the Corporation
is not responsible for actions taken by the lUldersiglled in reliance on a preliminary commitment by the
Corporation. The Applicant C01l1llUtS that no qualified residents \,.ill be refused occupancy because they have
Section 8 vouchers or certificates. The Applicant ftu1her conullits to actively seek tenants from public housing
waiting-lists.
If preliminary funding. is approved. the Applicant COllllluts to participate in the statewide housing: locator system
as required by Florida Housing.
The Applicant and all Financial Beneficiaries haye read all applicable COlporation rules govenling this
Application and have read the I1ls01lCtions for completing tIus Application and will abide by the applicable
Florida Statutes and adnulustrative rules. including. but not limited to. Rule Chapters 67-21 and/or 67-48. Florida
Administrative Code. If applying for the He Program. the Applicant and all Financial Beneficiaries have read.
understand and will comply v-ith section 42 of the Intemal Revenue Code, as amended, and all related federal
regulations. If applying for the HO!\,fE ProgranL the Applicant and all Financial Beneficiaries have read,
lUlderstand and will comply with 24 CFR Part 92, as amended, aJld all related federal regulations.
In cOlll"jideration for the COlponHioll processing and scoring- this Application. the Applicant and all Financial
Beneficiaries understand and agree that the Corporation shall hear appeals only pursuant to Rules 67-21.0035 and
6i-4S.005, F.A.C.
If applying for He. the lUldersigned understands and agrees that in the event that the Applicant is inyited into
credit unclerv-Titing. the Applicant must submit IR5 Forms 8821 for all Financial Beneficiaries in order to obtain a
recommendation for a Housing Credit Allocation.
TIle undersigned is authorized to bffid all Financial Beneficiaries to this cettificatioll and wanant)' of truthfulness
and completeness of the Application.
Under the penalties of peljlUY, r declare and certify that I have read the foregoing and that the infolluation is tme,
conect and complete.
Signature of Applicant
Name ("]led or printed)
Title ("]led or printed)
TIus certification form \\ill no! be considered and the Application will automatically be rejeCTed without the oppornmity to
ClU'e if. at Application Deadline. the completed form, reflecting an original signanu'e, is not prmided in the Application
labeled "Original Hard Copy" at Application Deadline or if the fann contains corrections or 'white-out' or is scanned,
imaged. altered. or retyved, Signatures ill blue ink are prefened. 11le certification lllay be photocopied.
Exhibit
UAI016 (Re\".5-09)
6;-U:'OO~I)(!);67.21_003(I)faJ.fAC.
Agenda Item NO.1 OB
2009 Universal Cycle - Declaration of Priority I Related Applicatij,AA~ ~r~~
The following is a listing of the Development Name and County for All of the Related
Applications within the Pool of Related Applications designated as Priority I Applications.
Development Name for Each Related Application County
Designated as a Priority I Application (where
Development
"ill be located)
If this declaration fOl1n contains conections or 'white-out' or if it is scamled, imaged, altered
or rel)ved, the Application will be deemed to be a Priority II Application. This fOl1umay be
photocopied.
Exhibit
l.'AI016~'_05_09)
67.48004{IXll):67-11003(IXI),F.AC
2009 UNIVERSAL CYCLE - DEVELOPER OR PRINCIPAL OF
DEVELOPER CERTIFICATION
Agenda Item No.1 08
May 12, 2009
Page 5 of 36
Name ofDeyelopment:
Name of Deyeloper:
Name' of Principal of Developer_ if applicable:
Address of Developer:
(stre~ address, city, stall")
Telephone No. of Developer:
Fax No. of Developer:
E.Mail Address (if available):
Relationship to Applicant:
As the Developer or Principal of the De\'eloper of rhe referenced De'\:elopm€llt. I ce11ity that I have the requisite skills,
experience and credit worthiness to successfully produce the wilts proposed by tllis Application. I further cenif)' that the
design. plans. and specifications for the proposed Development will comply with all federal. state and local requirements and
the requirements of the Federal Fair Housing Act as implemented by 24 CFR 100. Section 504 of the Rehabilitation Act of
1973. and Titles II and III oftlIe A..melicans with Disabilities Act of 1990 as implemented by 28 CFR 35. incorporating the
most recent amendments and other legislation. regulations. niles. and other related requirements which apply or could apply to
the proposed Den~lopll1ent. I baye developed and completed: i.e.. the certificaTe of occupancy has been issued for at least one
building. at least tv,,'o affordable rental housing developments. at least one of which cons1"ts of a total number of mnts no less
than 50 percent of the total number of mllts in the Development pl'Oposed by tIllS Application. as e\idenced by the prior
experience chart provided in this Application. I lmderstand I am the Developer or Principal of the Denloper of record for this
Development and that. if funded by the Corporation, I will remain in this capacity until the De\'e]opment has been completed.
I cenify that neither the Developer. Applicant. any Principal or Financial Beneficiary has any existing Developments
participating in Corporation programs that remain in non-compliance with the IRC applicable rule chapter. or applicable loan
doctunents and for which any applicable cme peIlod g::ranted for correcting: such non-compliance has ended. I further celiify
that the infommtion pro\ided within tIllS Application is tl1le and conect.
Signarure of Developer or Ptincipal of Developer
Pt'int or Type Name of Signatory
APPLICA.'H'S CERTIFICATION
I certify that the Developer identified above will serve as the Developer of the proposed Development.
Applicant's Signature
Print or Type Name of SignatOlY
If this certification contains corrections or 'white-out', or if it is seaIllled. imaged. altered. or retyped, the Application will fail
to meet threshold The certification may be photocopied
UAI016 (Rev. 5--Q9)
67-4S.0IJ4{IXa}: 67.21003(IXa}, F AC
Exlribit
Agenda Item No.1 OB
May 12, 2009
2009 U~IVERSAL CYCLE _ MA~~AGE~1E1U AGENT OR P~CIPAL We 6 of 36
l\L>\..c'\'AGEME~T AGENT CERTIFICATION
Name of Development:
Name of Management Agent:
Name of principal of Management Agent, ,fapphcabl,:
Address of Mana!:!ement A!:!ent:
(strffi address, city, statE.')~ ......
Telephone of Management Agent:
I celtity that I have the requisite skills and kilOwledge of affordable housing management
requirements to successfillly manage the lmits proposed by this Application and that I have
specific experience in the management of affordable rental housing and have successfully
managed at least two affordable rental housing propenies for at least two years each, at least
one of which consists of a total number of units no less than 50 percent of the total number of
units in the Development proposed by this Application, as evidenced by the prior experience
chait provided in this Application. I fillther celtify that the proposed Developmeut will
comply with all federal, state and local requirements and the requirements of the Federal Fair
Housing Act as implemented by 24 CFR 100, Section 504 of the Rehabilitation Act of 1973
and Titles II and III of the A,mericans with Disabilities Act of 1990 as implemented by 28 CFR
35, incOlvorating the most recent amendments and other legislation, regulations, mles and
other related reqnirements which apply or could apply to the proposed Development willie
nnder our management. I fillther celtity that the infol1nation provided above is tme and
conect.
Signature of Management Agent or principal of Management Agent
- -.-
Print or Type Name of SignatOlY
If this celtification contains cOlTections or 'white-out', or if it is scanned, imaged, altered, or
re1)ved, the Application will fail to meet threshold. TIle cenificationmay be photocopied.
UAI016 (Rev. 5-09)
6"7-4S.004(IXa);6-:'-!1.003(I)(a).FAG
Exlribit
Agenda Item NO.1 08
May 12, 2009
2009 l"iIVERSAL CYCLE - GEl\"ERo\L CO:>iTR.\CTOR OR QUALIFYIl\'G AGENf'age 7 of 36
OF GDiERU CONTRACTOR CERTIFICATION
Name of DeveJoprnent:
Name of General Contractor:
Name of qualifying agent of General Contractor. ihpplicable:
Address of General Contractor:
(street acl.ciress, city, s.tate)
Telephone of General Contractor:
Florida License Number of SignatOlY:
Expiration of License
Date (nnniyyyy)
I certify that I am a General Contractor as defUled by Rules 67-2landlor 67-48, F.A.C, and licensed in the State
of Florida with the requisite skills, experience and credit worthiness to successfully produce the units proposed by
tlllS Application and that I have been the General Contractor on at least tv,Q completed den'Iopmellts of similar
deyelopment category and deyelopment type. at least one of which consists of a totalmIDlber of units no less than
50 percent of the totalllumber of units in the Development proposed by this Application. as e,"ideuced by the
prior experience Ch1l11 provided in this Application. I fiu1her cel1ify that I \\ill constl1lct the proposed
De\'elopmellt in accordance with the design plans and specifications as prepared by the licensed
..-\rchitect'Ellgineer. In recognition and SUPPOIt of the implementation of Florida's welfare ref01TIllegislation. I
ce1tify my willingness to encourage the hiring: of welfare-la-work or self-sufficiency type program participants in
the cOllstnlction of the proposed De\'elopment. and to prm'ide s1Jch substantiating doclUuentation regarding the
incorporCltioll of such program participants in the work force as may be requested by the servicing agent in
COlljlUlctiol1 with construction loan draw disbursements. I fiu.ther cenify my willingness and intention to enter
into good faith negotiations or pmticipate in a bidding process \\-it11 the Applicant to act as the General Contractor
for tilis proposed Development and that the infol111ation proyided aboye is tme and coneel.
:\"OTE: If the Applicant is a Public Housing Authority \\ith prior deyelopment experience. or is othenvise
subject to the Competitive Consultants Negotiations Act. it 111ay haye the General Contractor :fi:OIll a prior
deyelopmellt execute tillS ce11ificatioll. TIle intent of this provision is to allow experienced Public Housing
Authorities or other regulated entities to haye all OPPOliUllity to llleet threshold without \iolatioll of bidding
procedures. Public Housing Authori.ties without prior den~lopment experience lUust joint yentme with an
experienced deyelopme1l1 eutity in order to palticipate in tIlis Funding Cycle.
Signamre of General COllU'actor or qualifying agent
Print or Type Name of Signatory
If this certification contains con'ectiolls or 'white-out'. or if it is scanned, imaged, altered. 01" retyped. the Application will fail
to meet tlu"eshold. The celtificatiou may be photocopied.
UAI016 (Rev. 5-09)
F-4S_004(I)(a}; 6:'-2LOO-,(I)(a).FAG
Exhibit
2009 uNIVERSAL CYCLE - ARCHITECT OR ENGIl\'EER
CERTIFICATION
Agenda Item NO.1 08
May 12, 2009
Page 8 of 36
Name of Development: __..__.__._.___....______.
Name of A.rchitect or Engineer:
Address of A.rchitect or Engineer:
(street address, city, state)
Telephone of Architect or Engineer:
Florida License Number of SignatOIY:
Expiration of License:
Date (mmiyyJ'Y)
I certify that I am a Florida licensed Architect and/or Engineer with the requisite skills and
experience to provide the professional services needed to successhrlly produce the units
proposed by this Application aud that I have experieuce with more than one previous
development of similar development categOIY and developmeut type, at least one of which
consists of a total number of writs no less than 50 percent of the total number of units in the
Development proposed by this Application. I hnther cenify that the design, plans and
specifications for the proposed Development will comply with all federal, state and local
requirements and the requirements of the Federal Fair Housing Act as implemented by 24 CFR
100, Section 504 of the Rehabilitation Act of 1973 and Titles II and III of the Americans with
Disabilities Act of 1990 as implemented by 28 CFR 35, incOIporating the most recent
amendments and other legislation, regulations, mles and other related requirements which
apply or could apply to the proposed Development. I hather certify my willingness and
intention to enter into good faith negotiations or participate in a bidding process with the
Applicant to act as the Arclritect and/or Engineer for this proposed Development and that the
infol1nation provided above is tme and COlTecl.
Architect or Engineer's Signature
Print or Type Name of SignatOlY
If this certification contains cOlTections or 'white-ont'. or if it is sealmed, imaged altered, or retyped, the Application will fail
to meet threshold. The cel1ification may be photocopied
UAI016 (Rev. ~"'(}9)
67-4S.004(lXa): 67-:!lOO3(1Xa). F A_C
Exhibit
Agenda Item NO.1 OB
May 12, 2009
Page 9 of 36
2009 C'iIVERSAL CYCLE - ATTOR;'\TEY CERTIFICATION
FOR M~fRB OR HO~'IE APPLICA TIO"'S ONLY
Name of Development:
Name of Attomey:
Address of Attomey:
(street address, city, state)
Telephone of Attomey:
Florida Bar Nnmber of Signato!)':
I celiifY that I am a member in good standing of The Florida Bar with the requisite skills and
experience to provide the professional services needed by the Applicant to produce the units
proposed by this Application, I fm1her cel1ifY my willingness and intention to enter into good
faith negotiations with the Applicant to act as the attomey of record for this proposed
Development and that the infomlation provided above is U1.1e and coneel.
Attomey's Signature
Print or Type Name of Signatory
If this celiification contains cOITections or 'white-out', or if it is scalllled, imaged, altered, or
retyped, the Application will fail to meet threshold, The cel1ification may be photocopied,
UAtOl6 (Rev 5-<J9)
(i74S_00~IX/l.): 67.':':1.003(1Xll)_F AG
Exhibit
Agenda Item NO.1 OB
May 12, 2009
Page 10 of 36
2009 U:\fIVERSAL CYCLE - ATTOR."IEY CERTIFICATION
4% (Competitive and :\fon-Competitive)
andlor 9% (Competitive)
HOl'SI:"oIG CREDIT APPLICATIO"S O:"olLY
Name of Development:
Name of Attomey:
Address of Attomey:
(street address, city, state)
Telephone of Attomey:
License NlUllber of SignatOIY:
State:
I cerlify that I am a duly licensed attomey in good standing with the requisite skills and
experience to provide the professional services needed by the Applicant to produce the units
proposed by this Application. I fllllher cerlrfy my willingness and intention to enter into good
faith negotiations with the Applicant to act as the attomey of record for this proposed
Development and that the infol111ation provided above is tme and COITect
:\fOTE: To the extent that the Corporation requires it an attomey licensed to practice law in
Florida and acceptable to the COlporationmust provide the enforceability opinion.
Attomey's Signature
Print or Type Name of Signatory
If this cerlification contains conections or 'white-out', or if it is scanned, imaged, altered, or
retyped, the Application will fail to meel threshold, The cenificalion may be photocopied.
UA1016 (Re-v. 5-09)
67~_O().$(IXll)~ 67_21 ,003(lXaJ_ F AC.
Exhibit
Agenda 11em NO.1 OB
May 12, 2009
Page 11 of 36
2009 UNIVERSAL CYCLE - CERTIFICATIO~ OF ACCOU~TANT
Name of Development:
Name of Accountant:
Address of Accountant:
(street address, city, state)
Telephone of Accountant:
License Number of Signatory:
State:
I certifY that I am a licensed Certified Public Accountant witl1 the requisite skills and
experience to provide the professional senices needed by the Applicant to produce the units
proposed by tl1is Application and that I have provided professional aCCotUlting services on
more than one previous affordable housing development ~nd th~t, if tlus Applic~tion seeks
Housing Credits. I have prior experience with tax credit accounting procedures, I firrther
certifY my willingness and intention to enter into good faitl1negotiations witl1 the Applicant to
serve as the ,\CCotllitant for this proposed Development ~nd that the infollnation provided
above is tme and conect.
Accountant's Signaun'e
Print or Type Name of SignatOlY
If this certification contains COlTections or 'white-out', or if it is scanned, imaged, altered, or
ret)ped, the Application will fail to meet threshold. TIre certificationlllay be photocopied.
UAI016 (Rev. 5--(9)
ti7-4S.004(I){aj; 67_~1.003(IXaJ- FAC
Exllibit
Agenda 11em NO.1 OB
May 12, 2009
Page 12 of 36
2009 U:\'IVERSAL CYCLE - SERVICE PROVIDER OR PRDlCIPAL
OF SERVICE PROVIDER CERTIFICATIO:'ll
ASSISTED LIVING FACILITY DEVELOPME:'IITS ONLY
Name of Development:
Name of Sen~ce Provider:
Name of principal of Service
Provider, if applicable:
Address of Service Provider:
(street address, city, state)
Telephone of Sen/ice Provider:
I certify that I have the requisite skills and knowledge of assisted living facility sen~ce
provision to successfully provide or coordinate services for the residents of this Development,
as proposed by this .'"pplication. I finther ceItify that I have specific experience in assisted
living service provision or coordination and have successfillly provided or coordinated
services for at least two assisted living facilities for at least two years each, at least one of
which consists of a total number of units no less than 50 percent of the total number of units in
the Development proposed by this Application, as evidenced by the prior experience chaIt
provided in this Application, and tlwt I am knowledgeable of all federal, state and local
requirements and the requirements of the Federal Fair Housing Act as implemented by 24 CFR
100, Section 504 of the Rehabilitation ,\ct of 1973 and Titles II and III of the A.mericans with
Disabilities Act of 1990 as implemented by 28 CFR 35, Assisted Living Facility and licensure
reqnirements as implemented by Chapter 429, Part I, FS. and Rule Chapter 58A-5, F.A.C.,
incOl1JOrating the most recent mnendments and other legislation, regulations, mles and other
related requirements which apply or could apply to the proposed Development. I fitrther
ceItify that the infol1nation provided above is tme and conect.
Signahrre of Service Provider or principal of Service Provider
Print or Type Name of Signatory
If this certification contains cOlTections or 'white-our, or if it is scmmed, imaged, altered, or
retyped, the Application will fail to meet threshold, The ceItification may be photocopied.
UAI016 (Rev. 5-09)
6:-l-S()(l..f(I;).); 6:_21 OOHIXa1.FAC.
Exhibit
Agenda Ilem NO.1 08
May 12, 2009
Page 13 of 36
2009l"(I\'ERSAL CYCLE ~ LOCAL GO\'E&,~n:C'iT \'ERIFICAll0C'i OF
QrALIFICATIOC'i AS rRBAc'\' I:\'~FILL DEVELOP'\n:".
Name of Development:
Development Location:
(At am:ini.n::a..tm, provide the address assi~ by tb~ Uni!ed SUtes Poml Sen~, including !he address number, ~trume and city, ocifthC' a~s ms oot}~
been ....s:igned, plmide the- strm mme, closest de-siguated intersection and city.)
Local Govemment:
The City/Collllty of
commns that the Development
(Name of City or CmUlty)
identified above meets the following cliteria:
L The proposed Development is located on a site or in an area that is targeted for in-fill housing
or neighborhood revitalization by the local, county, state or federal govemllleut as evidenced
by its inclusiou in a HUD ElllpOWet111emlEnterplise Zone: a HUD-approved Neighborhood
Revitalization Strategy: Florida Enterplise Zone: area designated lmder a COllllllUnity
Development Block Grant (CDBG): area designated as HOPE VI or a Front Porch Florida
Conllnunity: or a Comnmnity Redevelopment Area as desclibed and defined in the FlO1ida
Conll1lUnity Redeveloplllent Act of 1969: or the proposed Development is located in a
qualified census tract and the development of which contributes to a concened connmmity
revitalization plall~ and
2. TIle site is in an area that is ah'eady developed and is part of an incorporated ar'ea or existing
urban service area: and
3, The proposed Development is not located within the Small County Category,
CERTIFICATION
I cenify that the above information is tme and correct.
Signahu'e
Print or Type Name
Plint or Type Title
TIns cenification must be signed by the clnef appointed official (staff) responsible for such approvals,
lv!ayor. City Manager. COlliUY Manager/Administrator! Coordinator, or Chairperson ofthe City
COlmciI or COlUIty COlllllnssion. Other signatories ar'e not acceptable. If this cenification is
inappropriately signed, the Application will not qualify as an Urban In-Fill Development.
If tlle cenification contains conections or .white-out' or if it is scanned, inlaged, altered, or retyped, the
Application will fail to qualify as an Urban In-Fill Development and \\ill fail threshold, The
cenification may be photocopied.
UAlOl6 (Rev 5,()9)
67-4S_~I)(a): 67-11003(1)(11.), F AC.
Exltibit
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Agenda Item No, 108
2009 U~rVERSAL CYCLE ~ LOCAL GOVER,'\-:\1E:\'T VERIFICATION OF STAn'S May 12, 2009
OF SITE PLo\.c'\' APPROVAL FOR \fl'LTIF,o\.c\flLY DEVELOP\1EI\TS Page 15 of 36
Name of Development:
Development Location:
(At il wini.nn.u:u. provide the address assigned bytht Uwted States Postal Sc-viCC', mcluding the address number, street~ andciry, or iftbe 2ddress has not yet
bno:nas~igned, pro\idetht: smctname, cl~st cksignatedintersection :mdot)'.)
Development Type:
(P:illt IDAA of2009 Uni\-'~sal Cycle Application)
Total Nmnber of Units in Development:
(PMt mA6. of 2009 Universal Cycle Applicatlon)
Zoning Designation:
Mark the applicable statement:
1. 0 The above-referenced Development is new construction or rehabilitation with urn' constmction and the
final site plan, in the zoning designation stated above, was approved by action of the
on
(u-gally AuthorizM Body"')
Date (nuu1dd'yyyy}'I<*
2. 0 TIle abo\'e-referenced Development is new consQuction or rehabilitation with new COllstI11ction and this
jurisdiction proyides either preliminary site plan approval or conceptual site plan appwyal. The
prelim.inary or conceptual site plan. in the zoning: designation stated above, v..-as approved by action of
the on
(Legally Authmi=:! Body*)
Date (mmlddlyyyy) ..
3_ OThe above-referenced Development is lle\V cOllstIuction or rehabilitation with new constlUction and
requires site plan apprm-aI for the new constI11ction work. Howe\'er. this jurisdiction pro\-ides neidler
preliminary site plan apprm'alllor concepnml site plan approval. liar is any other similar process
provided prior to issuing final site plan approval. Although there is no preliminary or conceptual site
plan approval process and the f111al site plan approval has not yet been issued, the site plan.. in the zoning
designation stated above. was reviewed by
on
(Legally Authonzw Body.)
Dare (mm/ddlyyyy) ..
4, 0 The above~referellced Development in the zoning designation stated above, is rehabilitation without any
new constmctioll and does not require additional site pIau approval or similar process.
*- Legally AulhO:rized Body" is Dot :w individual AppliC31lt must sbte the name of the City Council, County Commission, Board, Dep;ittme1lt. Division, etc.,
with authmity OUT!>llc:h marten
** Dak Illl1St be"on or before" the AppliC2tion Deadline.
CERTIFICATION
I certify that the City/County of
bas vested in me the authority to verify status of
(N~ of city or County)
site plan approval as specified above and I fin1her certify that the infol1nation stated above is tlUe and correct.
Signanrre
Prill! or Type Name
Print or Type Title
TIus certification must be signed by the applicable City's or COlUlry'S Director of Plaru1i.ng: and Zoning:. chief appointed
official (staff) responsible for determination of issues related to site plan approyal. City Manager. or COUllty
l\fanager/Administrator/Coordinator. Signahu'es from local elected officials are not acceptable. nor are other signatOlies. If
this cel1ificatioll is applicable to this Deyelopmeut and it is inappropriately signed. the Application will fail to meet threshold.
If this cel1ification contains conections or 'white-out'. or if it is scmmed. imaged. altered. or ret)ved. the Application will fail
to meet threshold. Tile certification IllRy be photocopied.
UAlO16 (Rev. 5--09)
674S,004(1)(a);67.21.D03(I)(a).FAC.
Exhibit
Agenda Item No.1 08
May 12, 2009
Page 16 of 36
2009 C,,'IYERSAL CYCLE - LOCAL GOYER"IME:-iT \'ERlFICATIO:-i OF STATrs
OF PLAT APPROVAL FOR Sr:-iGLE-FA.\ULY RE:-iTAL DEYELOP:\IE:-iTS
Name of Development:
Development Location:
(At 3 minimum. prO\ide the addn--s& a.ssign~ by the l.1niloo Stlle-s Postll Sen:i.ce, including the' ~I"SS number, street nanr and City. or lfthe adchess has not yet
been :migned. prmi.& the street~. clo~st designated inten;ection and city.)
Mark the applicable statement:
LO
The above-referenced Development is new constmction or rehabilitation with
new constmction and Ihe final plat was approved by action of
on
(Legally Authorized Body*)
(Dale -Illm/dd/yyyy) **
2.0
The above-referenced Development is new constmction or rehabilitation with
new construction and the preliminary or conceptual plat was approved by action
of on
(Legally Authorized Body*)
(Date - nuulddlyyyy) *.
3.0
The above-referenced Development is rehabilitation withont any new
constmction and does not require additional plat approvaL
* "Legally Authorized Body'. is not all illdi,'idual. Applicant must ~tate the name of the City CounciL County
Commission, Board. Department. Di,'isioll. etc.. ,...itb authority oyer such matters.
** Date must be "on or before' the Application Deadtme
CERTIFICATIO,""
I cer1ify that the City/County of
has vested in me the
(Name of City or CollDty)
authOlity to verifY status of plat applOval as specified above and I fm1her certify that the
infol1nation above is true and conec!.
Print or Type Name
Signature
Print or T)1)e Title
TIlis cenificarion must be sig:ned by the applic;lble City's or Cailluy's DireClar of Plalll1ing and Zoning. chief appointed
official (staff) responsible faT detenllinatioll of issues relcned to plat appwraL City Manager. or County
!\.fanager/Adm.inhtrator/Coordi.nator. Signatures from local elected officials are not acceptable. nor are other signatories. If
this cenificarioll i<; applicable to this De\-elopmem and it is inappropriately signed. the Application will fail to meet threshold.
If tltis ce11ification contains corrections or 'wltite-out'. or if it is scanned. imaged. altered or retyped. the Application will fail
to meet threshold. TIle certificJtion lllay be photocopied
UAlO16 (Rev. 5-09)
67-1S.{l()4{1)(a): 67.:!1.00J(IXs}' FAC
ExJlibit
Agenda l1em NO.1 OS
May 12, 2009
Page 17 of 36
2009 UNIVERSAL CYCLE - VERIFICATION OF AVAILABILITY OF
INFRASTRUCTURE - ELECTRICITY
Name of Development:
Development Location:
(At a nlinimum, provide ~ address assigned by the Ututed State. Postal Senri~, including the addtess nWlllJeL street name and city. or ifthc: address bas: ootyet
been ;lSsigned. prot1.df.the street llilIUe, cloSl:'st designated intersection and city_)
TIle Imdersigned service provider confnUls that on or before
Date (mmiddJyyyy)*
I. Electricity is available to the proposed Development.
2. There are no impediments to the proposed Development for obtaining electric service other
than payment of hook -up or installation fees, line extensions to be paid for by the Applicant in
connection with the constmction of the Development, or other snch rontine administrative
procedure.
3. To the best of our knowledge, no variance or local hearing is required to make electricity
available to the proposed Development.
4. To the best of our knowledge, there are no moratoliwns pertaining to electric selvice which are
applicable to the proposed Development,
'" Date nrust be "on or before" the Application Deadline.
CERTIFICATION
I certify that the foregoing infol1nation is true and COlTect.
Signal11re
Name of Entity Providing Service
Print or Type Name
Address (street address., city, state)
Print or Type Title
Telephone Number (including area code)
TIus cet1ificationmay not be signed by the Applicant, by any related pat1ies of the Applicant, or by any Principals
or Financial Beneficiaries of tile Applicant. In addition. signatures from local elected officials are not acceptable.
If dIe certification is applicable to this Development and it is inappropriately signed, the Application will fail
du'eshold.
If this certification contains conectiolls or <white-out', or if it is scanned, imaged, altered, or retyped. the
Application will fail to meet threshold. TIle certificationlllay be photocopied.
UAI016 (Rev. 5-09)
157--t.S.OO4{IXa); 67.21,OO3(1Xll),F AC
Exhibit
Agenda Item NO.1 OB
May 12, 2009
2009 to'I\'ERSAL CYCLE _ \'ERlFICA TIO,", OF A VAILABILlT{'age 18 of 36
OF IXFR>\,STRtTCTrRE - WATER
Name of Development:
Developmelll Location:
(At a mini:nnmt. prol;idc the address assigned by tb~ Uuited States Post:U &rvicc. including the address number. stI<<t~:met city, or if the ~shas nol yet
btt:n ;lSsigned, provide ~ str~t name. closest de~gnatcd intersection and city.)
TIle lmdersigned service provider confIrms that on or before
Date (nun/ddi)')'}')').
L Potable water is available to the proposed Development.
2. TIlere are no impediments to the proposed Developmelll for obtaining potable water service
other dmn payment of hook-up or installation fees, line exteusions to be paid for by the
Applicant in connection with the constmction of the Development, or other such routine
administrative procedure.
3. To the best of our knowledge, no variance or local bealing is required to make porable water
available to the proposed Development.
4. To the best of om knowledge. there are no moratmiums peltaining to potable
water which are applicable to the proposed Developmelll.
* Date must be "on or before" the Application Deadline.
CERTIFICATIOX
I celtity that the foregoing infollllation is tme and conect.
Name of Emit}' Providing Service
Signanu'e
Print or Type Name
Address (street address, city, state)
l'1int or Type Title
Telephone Number (including area code)
TIus ceI1ification may not be signed by the Applicant. by any related parties of the Applicant. or by any Principals
or Financial Beneficiaries of the Applicant. In additioll. sigllanrres from local elected officials are not acceptable.
If the certification is applicable to this Dewlopmeut and it is inappropriately signed, the Application will fail
threshold.
If tlns celtificatioll contains corrections or '\"rule-out'. or if it is scanned, imaged. altered, or retyped, the
Application will fail to meet threshold. The cel1wcatioll may be photocopied.
UAlO16 (Rev, 5~09)
IP..-lS{)(l4(I)(a):6;-2100:;'(l)(a).L~C
Exhibit
Agenda Item NO.1 OB
May 12, 2009
Page 19 of 36
2009 UCIIIVERSAL CYCLE - VERIFICATIOCII OF AVAILABILITY OF
ICIIFR<\STRUCTL'RE - SEWER CAPACITY, PACKAGE TREATMEXT, OR SEPTIC L'\..'\'K
Name of Development:
Development Location:
(At a mininnu:n, prmide th~ ~ assigned by thr UniTed Stites Postal Servicc. including the' address Dlu:nbet-, stItttnanlf' and city, or lfthe address has not)'et
been assi~ prOl..ide tht street name, closest designal:ed intersection and city.)
The lUldersigned service provider or pemlltling authOlity confirms that on or before
0310 (mmldd/yyyy)'
L Sewer Capacity, Package Trea1Il1ent, or Septic Tank is available to the proposed
Development.
2. TIlere are no impediments to the proposed Development for obtaining the specified waste
treatment service other than payment OfIlook-up or installation fees, line extensions to be paid
for by the Applicant in connection with the constmction of the Development, or other such
routine administl'ative procedure.
3. To the best of our knowledge, no variance or local hearing is required to make tills service
available to the proposed Development.
4. To the best of our knowledge. there are no moratoriums penaining to this service, which are
applicable to tile proposed Development.
* Date must be "on or bl"fore" the Application Deadlme
CERTIFICATIOX
I certifY that the foregoing information is Que and COlTect.
Signamre
Name of Entity Providing Service
PIint or Type Name
.l\ddress (street address, city, state)
Print or Type Title
Telephone NlUnber (including area code)
This celtification may not be signed by tile Applicant. by any related p<uties of tl1e Applicant, or by any Principals
or Financial Beneficiaries of the Applicant. In additi01L signatures from local elected officials are Dot acceptable.
If tile certification is applicable to this De\'elopment and it is inappropriately signed, the Application will fail
threshold.
If tIlls certification contains corrections or <white-out'. or if it is scanned, imaged, altered. or retyped, the
Application will fail to lUeet threshold. The certification may be photocopied.
UAI016 (Rev. 5~)
67..tS()(M{IXa);6;'-:!LOO3{I)(8).F.A.C.
Exhibit
Agenda Item ~Jo. 108
May 12, 2009
Page 20 of 36
2009 U!\'IVERSAL CYCLE - VERlFICA TIO:\' OF AVAILABILITY OF
I:\'FR~STRLCT{~-RO,~S
Name of Development:
DevelopmeIll Location:
(At a minimum p1"O\-ide the address assigned by the United States PostIl sen.1.ce, mc:1~ thC' ;dhr-ss number, strtt'tn~ and city or if the address has nol ~
bet'1l assigned. prmw the weco! 1l.3.Dle. closest design2ted imeu.ection:md city.)
The undersigned local govel1llllent representative coufll1llS that on or before
Date (mmJdd/yyyy).
I. Existing paved roads provide access to the proposed Development or paved roads will be
consUllcted as part of the proposed Development
2. 111ere are no impedimeIlls to the proposed Development using The roads oTher Than paymem of
impact fees or providing cmb cuts. nUll lanes, signalizatiOlL or secming required frnal
approvals and pel1uits for the proposed DevelopmeIll.
3. 111e execution of tliis verifrcation is not a granting of traffic concmTeney approval for the
proposed Development
4. To the best of om knowledge, there are no moratoriums pertaining to road usage which are
applicable to the proposed Development
* Date must be "on or before" the AppliC'atiou DE."adhne
CERTIFICA TIO:\'
I celtifY tltat tlte foregoing infol1nation is hue and conec!.
Signanrre
Name of Local GovelUment
Print or Type Name
Address (street address, city, slate)
Plint or Type Title
Telephone Number (including area code)
T11is cel1ification may not be signed by the Applicant. by any related panies of the Applicant or by ,my Principals
or Financial Beneficiaries of the Applicant. III additioll. signatures from local elected officiab are not acceptable.
If the cel1ification is applicable to this Deyelopment and it is inapproptiately signed. the Application will fail
t1u'eshold.
If tlus cel1ificatioll contains corrections or '\\'lute-out'. or if it is scanned. imaged. altered, or retyped, the
Application will fail to meet threshold. The certitication may be photocopied.
UA1016 (Rev. 5-09)
6(....:S~1)(aJ: 67_!i 003(lX~1. F AC
Exhibit
Agenda Item NO.1 OB
2009 t'1\lYERS_U CYCLE - LOCAL GOYER.'\~iE!\! \'ERIFICATIO]\, TILU DE\'ELOPlVIEJ\."t1<rs 12, 2009
CO'\SISTE!\! WITH ZO!\L\'G Al\'D LA,'\'D USE REGULATIO'\S Page 21 of 36
Name of Development:
Development Location:
(.4.l a minimum. provide the address assigned by tfuo Umtw. States Postal Service. mcludiug the address number, strffinam.- and city, oriftht' ~sbas not yet
been assigned, providt- the street name, closest designated intcrnctioo and city.)
Development Type:
(hrt IDA4_ of 2009 Unr..en;al Cycle AppliC.1lion)
Total Number of Units in Development:
(Part ID.A6. of2009 Uwven;;d Cycle Applic:uiOll)
The tmdersigned Local Govennnellt official confums that on or before
(1)
(2)
(3)
D..~ (mmlddiyyyy)*
The munber of units (not buildings) allowed for this development site (ifreSllicted) is:
and! or
if a PUD, the number of units (not buildings) allowed per development site is:
or
if not a PUD and development site is subject to existing special use or similar permit, nlllIlber
of units allowed for tIllS development site is: __: and
TIle zoIllng designation for the referenced Development site is
; and
The intended use is consistellt with ClUTent land use regulations and the referenced zoning
designation or. if the Development consists of rehabilitation, the intended use is allowed as a
legally non-conforming use. To the best of my knowledge, there are no additional land use
regulation hearings or approvals required to obtain the zoning classification or density
desclibed herein. Assuming compliance with the applicable land use regnlations, there are no
know1l conditions which would preclude conSll'llction or rehabilitation (as the case may be) of
the referenced Development on dIe proposed site,
* Dale must be "on or bdille" the AppliC-ati011 Deadline_
CERTIFICATION
I celiify that the City/County of
has vested in me the authotity
(Name of CityiCOU1lty)
to verify consistency with local land llse regulations and the zoning designation specified above or. if
the Development consists of rehabilitation, the intended use is allowed as a "legally non-confonning
use" and I further certify that the foregoing infonnation is true and correct. In addition_ if the proposed
Development site is in the Flotida Keys /\1'ea as defmed in Rnle Chapters 67-21 and 67-48, F.A.C., I
Miher cenify that the Applicallt has obtained the necessmy Rate of Grol'lth Ordinance (ROGO)
allocations fi'olll the Local GOVel1llllent.
Signature
Print or Type Name
Print or Type Title
Tlus cOltification must be signed by the applicable City's or COlmty's Director of Plamung and Zoning, chief
appointed official (staff) responsible for detellnination of issues related to comprehensive planning and zoning.
City I'vfanager. or County l\lanager/Admiuistrator/Coordi..nator. Signatures fl.-om local elected officials are liot
acceptable. nor ;,re other signatories. If the certification is applicable to this De\'elopment and it is
inapproptiate1y signed. the Application will fail 10 meet threshold.
If this cettiticatioll contains conecliolls or 'Ivhite-out'. or if it is scanned. imaged, altered. or retyped, the
Application will fail to meet threshold. The cenification may be photocopied.
UAI016 (Rev 5-09)
6;-l.S_004(1Xa): 67-::'Loo3nXal_ f AC.
Exhibit
Agenda Item NO.1 OB
I~ay 12, 2009
2009 F\'IVERSAL CYCLE - LOCAL GOVER"C\IE:\'T VERIFICA TIO:\' Taffle 22 of 36
PER'UTS ARE :\'OT REQLIRED FOR THIS DEVELOPME:\'T
Name of Development:
Development Location:
(At a mini.mun:t. prO\'ide thr: ~S6 assigned by th~ UnilM St.1leS Posta.! 5c'vi~. incJuding the address numba, street name and city_ or if the address has not reI
been assi~ pt"O\;&- the- sc-eel name, cl=sl rksigIWea iurmtttioa and city.)
Building pennits: Ifno building pelmits are required for the rehabilitation of the referenced
Development sile. complete the following cenifieation:
CERTIFICATIO:\'
I cenify That the foregoing infor1l1ation is tme and conect and that the City/County of
has vested in me the anthority to verify that the rehabilitation of the
(Name of City / County)
referenced Development site does not reqnire the issuance of building permits. In addition. if the
proposed Development site is in the Florida Keys Area as defined in Rnle Chapters 67-21 and 67-48,
F.A.C.. I further cenify that the Applicant has obtained the necessalY Rate of Gromh Ordinance
(RaGa) allocations from the Local Gove111ment.
Print or Type Name
SignaIl1l'e
Print or Type Title
This cenification must be signed by the applicable City's or Connty's Director of PI arming and Zoning,
chief appointed official (staff) responsible for detennination of issnes related to comprehensive
planning and zoning, City Manager. or C0ll11ty IvIanager ! Administrator! Coorclinator. Signatures
fimn local eleCTed otTlcials are not acceptable, nor are other signatories. If this certification is
applicable to this Development and it is inappropriately signed, this Application will fail TO meet
threshold.
If this cenification contains conections or 'white-out'. or if it is scanned. imaged. altered, or retyped,
the ApplicaTion will fail to meet threshold. The cenifieation may be photocopied.
UAI016 (Rev. 5-09)
6-:'...fSOO4{lXa): 6~.~I.r)(l].(IXa)_ F A.c
Exlribil
2009 U:\'IVERSAL CYCLE - VERIFICATIO"l OF ENVIRO'\"fE"ITAL
SAFETY - PHASE I El\"\'1RO"l:\1:E!\"TAL SITE ASSESSl\fE'\T
Agenda Item NO.1 OB
May 12. 2009
Page 23 of 36
Name ofD~velopIlle:ut:
Deyelopment Location:
(At a minim.nn. provilk the address aSSlgnM by the Uni-.ro States Postal $a."lce, mcluding the addIess Dumber. streetIldllle;md city. or If the address hasnoi yet
bec1 assigned provide the street name.. closest designated intersection and city.)
As a representative- of the finn that performed the Phase I Euv1rownental Site Assessme1lt (ESA), I certify that a Phase I ESA of the above
referenced Development site was conducted by the undersigned environmental finn as of and
(Date of Phase I ESA - mm/ddlyyyy)
such Phase I ESA meets the standards of ASTM: Practice fiE~1527-05_
Check all that apply in I1enlS 1,2 and 3 below:
L If the Phase I ESA is over 12 montm old from the Application Deadline for this Application, has the site's environmental
condition changed since the date of tIle original Phase I ESA?
DYes
D No
If"y es~, to demonstrate the condition of the site> the signatory must answer question (1) or (2) below:
o (I) an update to the original Phase IESA was prepared on (Date - mmiddlyyyy)
(Date of update must be 'within 12 months of the Application Deadline for this Application), or
0(2) a ne\\' Phase I ESA \\'3.S prepared on . . (Date - nunJddYY)-1')
(Date ofuev.-' Phase I ESA must be WIthin 12 months of the ApplicahOD Deadline for this Application).
Note: The CorporalloIl willllot consider a Phase II ESA to be a substitute for the updated Ph. I ESA or new Ph. I ESA
2. If there are one or more existing butldings on the proposed site, the presence or abst>nce of asbestos or asbestos containing
materials and lead based paint must h\" addres"ed either as B. part of the phase I ESA 01' as a separate rr-port The signatory must
indicate which of the following (Item a. or b.) applies:
D~. the phase I ESA referenced abo\'€:' addresses flit' pfl'sellCE' or absencE' of asbestos or a5;bestos containing materials and
lead based paint; or
Db. separate report(s) addressing the presence or absence of asbE"stos or asbestos containing materials and lead-based paint have
been prepared and the IUlde-rsigued has reviewed the separate report(s). Such separate report(s) may or tn.,)' not lxo
incorporated by reference in the PhaSE' I ESA.
3_ If the Phase I ESA diScloses potentml problems (including, but not limited to asbestos or asbestos contaming materials, lead~based
paint, radon gas, etc.) 00 the proposed site, the signatory must indicate which of the following (Item a., b., or c.) applies:
o a. eovironmi'ntal safety conditions on the s1fe require remediation and a plan that includes anticipated costs and estimated
time needed to complete th!' remeruation has been prepared, either as a part of th!' Phase I ESA or as a separate n>port;
or
D b. a Phase II ESA is required or recommended (the firm that performed the Phase II ESA, even if it is the same firm that
prepared the Phase I ESA, MUST complete and execute the Phase II Euvu"Onmental Site Assessment Venfication); or
D c. although environmental safety conditions exist on the site, no remediation or further shIdy is required or recommended
CERTIflCATIOX
I certify that the foregoing infonnation is true and correcl
Authorized Signature
Name of Firm thai Perfornled the Phase I ESA
Print or Type Name of SIgnatory'
Address ofEllvironmental Firm (street address, city, state)
Print or Type Title of Signatory
Telephone Number Includtng Area Code
This certification lUust bl" <;igned by a reptE"sentative of the fum that perfonned the Phase I ESA faT the proposed Development location. If
this certification contains corrections or 'white-out', or if it is scanned, imagl?d, altered, or retyped, the Application will fail to meet t.l1reshold_
The certification may he photocopIed_
UAlO16 (Rev_ 5--09)
67--tS.l>O-1(l)(a}; 6-:'-2LOO3(1)fa). F AC.
Exlribil
Agenda Item No.1 OB
May 12, 2009
20091'NIYERSAL CYCLE _ VERIFICATION OF El'IVIRONME:\T\l7ge 24 of 36
SAFETY - PIL\SE II ENVIRONMENTAL SITE ASSESSMENT
Name of Development:
Development Location:
(At a minimum, pro\i& the address :lssigned by the Uoited States Post:1! Servi~, lfiduding the ;ulw-esr; number_ streeT ~ and CIty, or if the dddres.s h.1S not yd
~ assignoi providl" the street~. closest designated iorm;ection and city.)
As a representative of the frnn that perfOlmed the Phase II Environmental Site Assessment (ESA), I
cenify that:
I. A Phase II ESA of the above referenced Development location was required or recommended
by the Phase I ESA. The Phase II ESA was conducted by the Imdersigned environmental fmn
as of in accordance with ASTM Practice #E-1903-97(2002).
(D:!te of Phase IT ESA ~ nunJddiyyw)
If the Phase II ESA is over 12 months old fi'om the Application Deadline for this Application,
has the site' s environmental condition changed since the date of the Phase II ESA?
DYes
D No
If "Yes". to demonstrate the conclition of the site. an npdate to the original Phase II ESA was
prepared on
(Date of Update to Phase II ESA -mm:dd/yyyy*)
.
Date of the update to the Pha~e II ESA. as stated above. HlUst be within 12 months of the
Applicmion Deadline for this Appliciltion)
?
If the Phase II ESA disclosed potential problems (inclnding. but not linlited to asbestos or
asbestos containing materials. lead-based paint. radon gas. etc.) on the proposed site. a plan
that includes anticipated costs and estimated time needed to complete the remediation has been
prepared either as a pan of tbe Pbase II ESA or as a separate report.
CERTIFICATIO'"
I celtify that the foregoing information is U1le and con'eet.
AurhOlized Signature
Name of Firm that PerfOlmed the Ph. II ESA
Print or Type Name of Signatory
Address of Environmental Finn (street addrl"SS, city, state)
Print or Type Title of Signatoty
Telephone Nnmber Including Area Code
This cet1ificatioll must be sig.ned by a represelltath'e of the fmn that perfol1l1ed the Phase IT ESA for the proposed
De,'elopment location. If this ce11ification contains con-ections or 'white-out'. or if it is scanned. imaged. altered,
or retyped, the Application will fail to meet threshold. TIle cenificationmay be photocopied.
UAI016 (Rev. 5-09)
6'-4S.004<I)[a):67.210D3(1Xa).FAC
Exlribit
Agenda Item NO.1 OB
May 12, 2009
Page 25 of 36
2009lT'l\IVERSAL CYCLE - VERIFICATION OF I:\'CLlTSIO:\' I:\' LOCAL HO:\fELESS
ASSISTA.'I'CE CONTIl'<l'L'M OF CARE PiAl'\' BY LEAD AGE;\CY
Name of Development:
Development Location:
(At;1 miniDwm pro,:ilk the' address :lSsigned by the UOltal Sl3tes Postal Service, mcluding tht- address number, mIX! n<Wle mdcity. or if the address has no! yet
been ;migntd, pro\'ilk the street name, dosest designated inl:~ou and city.)
Catclunent Area:
Lead Agency (if it Iras
been designated):
The Lead Agency for tire Catchment Area identified abm'e COnfll111S tlral the Deyelopment identified aboye meets
tire following criteria:
L TIre proposed Development is located within tire Catchment A.rea ideutified aboye:
2. The nature and scope of the proposed Development is in confonnance with the Local Homeless
Assistance ContinuuIll of Care Plan that is on me. at the time of Application Deadline. with the State
Office all Homelesslless: and
3. The proposed Development is specifically included in the list ofl'lcth'ities to be undertaken as pali of the
implementation of the Local Homeless Assistance Continuum of Care Plan that is 011 file, at the time of
Application Deadline, with the State Office on Homelessness.
CERTIFICATIO"l BY THE LEAD AGE'iCY OF J:\'CLl'SION J:\' LOCAL HOMELESS CONTI'\lTUM
OF CARE PL~'\':
I certify that the above infOlTIlatioll is tfile and con-ecl.
Signanlfe
Print or Type N time
Print or Type Agency Name
Print or Type Title
-OR-
The State Office on Homelessness confinns tlrat tire Development identified above meets the following criteria:
1. Tire proposed Development is loealed within tire Catclunent Area identified above, and
2. The proposed Development is in a Catchment Area for which no Local Homeless Assistance Continuum
of Care PIau has been recognized by the State Office on Home1essness at the time of Application
Deadline.
CERTIFICATION BY THE STATE OFFICE 0;\ H01\fELESS;\ESS THAT:\'O LOCAL HOl\fELESS
CO;XTThL'l!M OF CARE PLAN EXISTS:
I certify that Ihe above infonnation is tme and correct.
Sig;llamre
Print or Type Name
Print or T)1)e Title
TIus certification must be signed by the authorized signatory from the Lead Agency or from the State Office on Homelessness.
Other signatories are not acceptable. If the cenification is inappropriately signed. the Application \\ill not qualify for the
Homeless Demograpluc Commitment. If tbe certification cOlllains cOll.ections or ;white-out' or if it is scanned. inlaged.
altered. or retyped, the Application will fail to quality for the Homeless Demographic Conunitmel1t and ,",ill fail threshold.
The certification may be photocopied.
UAI016 (Rev. 5-09)
67-48,004{IXa)~ 67.2LOO3(1)(a). FAC.
Exlribit
Agenc8 Item No. lOB
2009 Universal Cycle - Applicant :\'otification to Special :\'eeds Househo\!f,,~e i~ ~?~~
RefeITal Agency
To:
(Names of AlL participating S~ia1 Nttds Housdmld Refnral Ag=cies for Ih~ COlwty wh~ th~ proposed ~\'elopment will be located, as
included on the florida Housing Fiwnc~ CQtJ)Ofarlon Special Ket'ds Household Referral Agency PanicipanOD List The- p.micipanOlllist is 3\6i1IDle
OD the COIporation' s Website w\\'wfloridahousingorg
From:
(Kam~ of Applicant. Name of Contact PaSO!]_ and rua.i.lmg Address)
This notification is to inform your agency. serving as a paniciparing Special Needs Household Refenal
Agency, that our organizarion is planning to apply for funding from Florida Housing Finance
COTporation in its 2009 Universal Application Cycle to develop affordable rental housing in
Coumy and. iffimded (i) a rnininlll11l of 50 percent of the units
Name afCounry
set aside for Extremely Low Income (ELI) Households will be reserved for a Special Needs
Households. as defllled in Rule 67-4SJJ02. F.A.C.. and (ii) dln'ing rhe credit undenHiting phase a
detennination will be made as to the population(s) ro be sen'ed and the applicable agreernent(s) will be
entered into between all!' organization and rhe applicable panicipating agency/agencies.
The following is preliminary illfolmation regarding the proposed Developmem:
Name of proposed Development: _.
Developlll€m Location:
(At :I minimum prO\-ick- the- addte~ assigned by the United Stn~ Postal Sen.ice. including thr a.ddress numbeL sln,'(.t n:une
and O[)'. or if the address has not yet been assigned. pro\"i~ the strtrtuame, closest designated intersection:md city.)
Total NIl11lber of Units in proposed Development:
SignanlIe of Applicant
Name (typed or printed)
Tille (typed or plIDted)
This notification \\ill not be considered and the Application will fail threshold if the notification contains conectio1lS or
'white-out' or if the notification is scanned. imaged_ altered_ or r~typed. This notification fOlUl Ulay be photocopied.
Exhibit
UAI016 (Re\'_ 5-09)
67-48004{I)(aJ;67.::':1003{1)(1I.).FAC
Agenda Item No.1 OB
May 12, 2009
Page 27 of 36
2009 U~IVERSAL CYCLE - LOCAL GOV'ERl\TMENT VERIFICATION
OF CONTRIBUTION - GR~"iT
Name ofDeyelopment
Development Location:
(At amininnun. prO\;d.! tb"address assigned by the United Stat:es Postal Smice, including the addres& number, S't:r<<"t name and city, Of if the a&:hss has oot yet
bet:n assigned, pr",ide the street name, closest designated ~tiou and city.)
On of before
Date (mmiddlyyyy).
the City/COlUlty of
cOlllmitted
(Name of City or County)
$ as a grant to the Applicant for its use solely for assisting the proposed Development
referenced above. The City/County does not expect to be repaid or reimbursed by the Applicant, or any other
entity. provided the funds are expended solely for the Development referenced above. No consideration Of
promise of consideration has been given with respect to the grant. For purposes of the foregoing, the promise of
prO\iding affordable housing does 110t cOllstiulte consideratioll. TIus grant is provided specifically with respect to
the proposed Deyelopmenl.
The sonrce of the grant is:
(eg.. SHIP. HOME. CDIlG)
The following govenmleut point of contact can verify the above stated contribution:
Name ofGm-ennnellt Contact:
Address (street address and city):
Telephone N limber:
of Date must be <Con or before" the Application Deadline_
CERTIFICATIO:\'
I cel1ify that the foregoing infOlmation is tme and con'ect and that this comnritment is effective tln'ough
Dare (mmiddlyyyy)
Signature
Print or Type Name
Telephone Number
Print or Type Title
This certification must be signed by the chief appointed official (staff) responsible for such approyals, 1..,13)'or. City Manager,
County Manager/Adnrinistrator/Coordinator, dlairperson ofrhe City CotmciVCollllllission or Chairperson of the Board of
CalUlly Conurllssioners. If the conttibution is from a Land Authority organized pursuant to Chapter 380.0663, Florida
Stanltes, tIus cel1ification must be signed by the Chair of the Land Authority, One of the authorized persons named abo\'e
may sign this form for certification of state. federal or Local Goverrunent funds initially obtained by or derived from a Local
Goyernment that is directly administered by an intermediary such as a housing fmance autl10l1ty. a COnlllltUllry reinvestment
cOlporarioo., or a state~certified COUlllltullty How,ing De\'elopment Organization CCRDO). Other signatolies are not
acceptable. TIle Applicant will not receive credit for this cOlluibution if the certification is improperly signed. To be
considered for points. the amOlUlt oftbe contribution stated on tIus form must be a precise dollar amount and cannot include
words such as estinlated. up to. ll1axinuul1 of. not to exceed. etc.
This cOllttibution will not be considered and the Application will fail threshold if the certification contains conections or
'wlute-out' or if dIe cel1ification is scanned. imaged. altered. or retyped. The certification may be photocopied.
'l11e Application may still be eligible for automatic points.
UAI016 (Rev. 5'{)9)
G7 -48_004(1))1.); 67-2i.003(lXa).. F AC.
Exhibit
Agenda Item NO.1 OB
May 12. 2009
Page 28 of 36
2009 UC'iIYERSAL CYCLE - LOCAL GOYER"ME'\T VERIFICATIO:" OF
CO:-!TRIBVTIO:\' - FEE WAIVER
To bE' eligildt' to be rOllsidpl'rd for points, a sheet showing the cOlDputations by which flu' total amount of
each fef' waiver is determiof'd IDU'it bt' attarht>d to this vrrifkation form. Computations should include',
where applicable. wain'd rei' amollnt per set-asidE' unit.
Name ofDeYe1oplllellt:
De\-elopmelll Location:
(At a rn.inimum pro>ide th~ address assigned by thr Ulllled StJtes Poml Ser\"'1Ce, Uld~ the ;ulW-l"S5 nlJll:lbeor, ~t D:l!Ir 3.nd city or if the ~s has not y~t
been assigned. protide- thr street name. d~!>>t cksi,!!1Wed inr~riOll ;md city)
A..1ll01111t of Fee \Vaiyer: $ Is thi5 8momlt based upon a per set-aside (affordable) unit
computation? C] yes D no (check one)
On or before
Date (nun/dd/n'YY).
the City/COIillty of
. pursuant to
(Name OfClty/County)
. waiYed the following fees:
(Reference Official Action, cite Ordinance or ResolulJon ~umber and Datl:')
No consideration or promise of consideration has been giyell with respect to the fee .wai\'er. For purposes of the
foregoing. the promise of proyiding affordable housing does not cOIlstimte consideration. This fee wai\'er is
pwyided specifically with respect to the proposed De~;elopl1lent.
The following gOyemmellt point of contact can yerify the aboye stated contribution:
Kame of Go\-enuuellt Contact:
Address (~t addre'is and city):
Telephone 1\"ll1uber:
"Date must be "on or before' the Application Deadline
CERTIFICATIO:\'
I certify that the foregoing infonuation and the computations stated 011 the sheet attached to this fOIDI are true and
conect and that this conunitment is effecti\'e through
Date (mm/ddlyyyy)
Pri.nt or Type Name
Siguanu.e
Telephone NlUl1ber
Plint or Type Title
NOTE TO LOCAL GOVERJ\1vIENl OFFICIA..L: \Vairers that are not specifically made for the benefit of tltis
Derelopmem bur are instead of general benefit to the area in wltich the Derelopment is located will NOT qualify as a
contribution to the Deyelopment. Further, the fact that no impact fees or other fees are leYied by a localjmisdiction for .<\..:.."nr
type of de\-elopment DOES NOT constitute a "Local GQvennnent Contribution" to the proposed Development. Similarly. if
such fees ARE Ie\'ied by the local jurisdiction but the namre of the proposed De\-elopment exempts it (e.g:" typically. a
RehabiJitMion Den~lopment is not subject to impact fees). for pmposes of this fonll. no "Loc~I Go\"ellunent Conniburion"
exists and no points will be awarded.
TIus cenification mlLS( be signed by the cmef appointed offidal (staff) responsible for snch appro\.als. Mayor. City J\1anager.
COllnty Manager/Administrator/Coordinator. Chairperson of the City COlUlcil/Coumllssion or ChaiIverson of dIe Board of
Catmty Commissioners. Other signatories are not acceptable. The Applicant 'will not recei\"e credit for this contribution if the
cenificatioll is improperly signed. To be considered for points. the amount of the contribution stated Oll this fonn must be a
precise dollar a1l101Ult and canllot include words such as estimated. up to. maximuill of not to exceed. etc.
TIllS conuiburion will not be considered and the Application will fail threshold if the cenificntion contains corrections or
'white~out' or if the cenification is scalmed. inmged. (jllen~d, or retyped. The cenificatiol1 may be photocopied.
The Application may still be eligible for automatic points.
UAI016 (Rev. 5--09)
6~...fS.oot(IXa). 67-21.003(I)I~)_EAC
Exhibit
Agenda Item NO.1 OB
May 12, 2009
Page 29 of 36
2009 UNIVERSAL CYCLE - LOCAL GOVERj'lMENT VERIFICATION
OF CONTRIBUTION - LO~"I
To bt' e1igiblt" to be cODsidere-d for points, a sheft sbo"ing the payment strt'am for which tbe net present
value of the loan ",as raknlated must be attached to this wl'ifiratioD form.
Name of Development:
Development Location:
(At.a mi:niImm1. provide the address aSSIgned by the Unrted S'bteS Pooul SeJv1ce, mcluding the ~s:~, stre'etn.ame and Clty. ocifthe admess: has: notye1:
hm1 assigned, provitk the Weet name_ closest designated imersection and city.)
Date (rum/dellyyyy).
the City/Comrty of_~
(Name of City or County)
cOIllmitted
On or before
in the form of a reduced interest rate loan to the Applicant for its use solely for
$
(loan amount)
assisting the proposed Development referenced abO\'c. The loan will bear interest at a rate of % per
atilllUll O"er a period of _ years. The loan"s repayment period, ;ullOltizatioll period. payment frequency and
other applicable terms are:
No consideration or promise of consideration has been gi\'en with re:.p::.-ct to the loan. For pmposes of the foregoing, the
promise of proYiding affordable housing does not constitute consideration. This loan is prmided specifically .with respect to
the proposed De\'elopment.
The following g:oyemment point of contact can 'i/erify the above stated cOlltnbutioll:
Name of GOye111lUent C olltact:
Address (street address and CIty):
Telephone I\mllber:
* Date must be "on or before" the Application Deadline.
CERTIFICATIO~
I certify that the foregoing illfol1natiol1 and the payment stream stated on the sheet attached to this form are true
and coneet and that this conlliutment is effective through
Date (nm1fdd1yyyy)
Signature
Print or Type Name
Telephone Nmuber Print or Type Title
This certification must be signed by the chief appointed official (staff) responsible for such approvals, Mayor, City Manager, County Manager
IAdministrator/Coordinator, Chairpef'ion of the City Counci1!Comnnssion or Chairperson of the Board of County CommissioDers If the
contribution is:from a Land Authority organized pursuant to Chapter 380.0663, Florida Statutes, this cernfication must be signed by the Chair
of the Land Authonty. One of the authorized persons named above may sign lhis form for cernfication of state, federal or Local Government
fimd.s imtJ.ally obtained by or derived from a Local Government that is directly adminis1ered by an intermediary such as a housing finance
authority, a commulllty reinvestment corporation, or a state-certified Community Housing Development Orgaruzatlon. (ClIDO). Other
signatories are not acceptable. The Applicant will not receive credit for this contribution if the certificatiou is improperly signro. To be
considered for points, the amount of the contribution '>tated on this form must be a precise dollar amount and cannot include 'words such as
estimated. up to, maximum of. not to exceed, etc.
TIns. contribution will not be eonsidere-d and the Application 'will fail threshold if the certification contains corrections 01' 'l.vhite---out' or if the
certi1icatiOll is sC31moo, imaged, altered, or rE"typed. The- certification may be photocopied.
The ApplicatioD may still be eligible for automatic points.
UA1016 (Rev 5-09)
67-4S.004{I)(a);6i.21.0Q3(1)(a}.FAC.
Exlribit
Agenda Item NO.1 08
May 12. 2009
Page 30 of 36
2009 UNIVERSAL CYCLE - LOCAL GOVER.'1.MENT VERIFICATION OF
CONTRIBUTION - FEE DEFERRAL
To bE' t'ligiblf' to bt' considered Cor points, a shrt't showing tilt" payment strt'3m for which tilt' DP' prl'sf'nt
valu. of tho f.. d.f.rral was ralrulat.d must b. attarh.d to this v.rillratlon form.
Name ofDe\'elopmellt:
De\'elopment Location:
(At a mmimum, prO\.i~ the address 6SSigned by the UnitM. States PosWSeI>,~. mcluding the address number. stlertnaar mdcity, or iftk address bas not yet
bem;lSSigned. provide ~ street wme.. clostst designated intersection;md cit)'.)
Complete the following:
On or before
Date (mmiddiyyyy)+
the City/County of comnritted 10 defer
(Name of Clty or COllllty)
$ in fees for the proposed Deyelopment referenced above. TIle fee deferral will bear
interest at a rate of 0'0 per a1l1lUIll oyer a period of years. TIle fee deferral repa)ll1ent period,
am0l1izatioll period. payment fl'equeney and other applicable tClTIlS are:
No consideration or promise of consideration has been g:i\'en v.ith respect to the fee defen'aL For pwposes of the foregoing:,
the promise of proYiding. affordable housing does not constimte consideration. This fee deferral is pro\'ided specifically with
respect to the proposed De\'elopment.
TIle following government point of contact can verify the above stated cOlluibution:
Kame ofGon~'Illlllent Contact
Address (street address and city):
Telephone Number:
* Date Dlll~ be "on or before" the Application Deadline_
CERTIFICATIO'\'
I certify that the foregoing. infolTIlation and the paylUent stream stated Oll the sheet attached to this form are hue
and conect and that tIlis C01l1lllltment is effective tlunug:h
Date (mmidd:y'YYY)
Sig.llattlre
Print or Type ~ 3me
Telephone Number
Prinl or Type Tille
This cenificatiOll must be signed by the chief appointed official (staff) responsible for such approyals. Mayor. City !v1anager.
COlUIty Manag.er /Administrator/Coordinator. Chairperson of the City Council/Commissioll or Chairperson of the Board of
County Commissioners. If dIe cOllniburioll is from a Land Authority organized pursuant to Chapter 380.0663. Florida
Statutes. this certification must be signed by the Chair of the Land AuthOIity. Other signatOlies are not acceptable. The
Applicant \l,'ill not receive credit for tills contribution if the certification is improperly signed. To be considered for points, the
ammmt of the connibntion stated on this form Ulllst be a pr.;:cise dollar amount and cannot include words sllch as estimated, up
to. ma.....imum of. not to exceed. etc.
TIus contIibutioll will not be cOllSidered and the Application -v;ill fail threshold if the celtificatioll contains con'ections or
'\\"hjte~out' or if th.~ certificntioll is scmllled. imaged. altered or retyped. The certification llmy be photocopied.
The Application may still be eligible for automatic points.
UA1016 (Rev_ 5-09)
6~-4S004flXaJ, 67-21003(I)(a). F.AC_
Exltibil
Agenda Item NO.1 OB
May 12, 2009
Page 31 of 36
20091",.VERSAL CYCLE - LOCAL GOVER"\'MEl\T VERIFICATIOX OF AFFORDABLE
HOrSI:\'G I"ICENTIVES EXPEDITED PERMITTING PROCESS FOR AFFORDABLE HOUSING
Name of Development:
Development Location:
(At a mininmm. provide the address assigned byth~ Unitrd StaleS Post3l Service. including the address number. stm't llaml.' mdcil~", orif~ address has not}rel
been assigned. provide fur. street I131De, closest ck-signa.led intersection and city.)
Name of City or County Govel11l11ent:
Name of Imisdiction that will issue building pelmits:
The City/County of
cmTently administers an expedited
(Name ofeir)' or COlUlty)
permitting process for affordable housing enacted by
(Ordinance, Resolution Number or citation of policy)
adopted
Date (lllmlddlyyyy)
CERTIFICATION
I certify that the above information is tme and conec!.
Signanu'e
Print or Type Name
Print or Type Title
This celtification must be signed by the chief appointed official (staff) responsible for issues related to
this incentive. Mayor, City Manager, Connty Mauager/Administrator/Coordinator, or Chairperson of
the City Council/Commission or Challperson of The Board of County Cormnissioners, Other
signatories are not acceptable. Zero points "ill be awarded if the cenification is improperly signed,
SignaTory must be a representative of the local govennnent that has enacted the incentive, For
plllposes of this fOlm only. if a Development is located within a nnmicipality but the inceutive is not
available in the city, Applicant may use county lllcentive. For example, if a Development is located in
a town which does not have inlpact fee requll'ements but the county has such requirements and they
have a reduction or waiver of these fees for affordable housing, the Applicant may submit a properly
executed Local Govenlluellt Verification of Affordable Housing Incentives Fonn from the COUIlty.
The Applicant will not receive credit for this incemive and the Application will fail tlu'eshold if The
celtification contains coITections or 'white-out' or if the cenification is scanned, llnaged. altered, or
retyped. The cettification may be photocopied.
UAI016 (Rev. 5-09)
67-48J)O~JXa); 67-21.003(IXll). F.AG
Exhibit
Agenda Item NO.1 OB
May 12, 2009
2009l~IVERSAL CYCLE - LOCAL GOYER'''IE-'\T VERlFICATlO:\' OF AFFO~lil~f 36
HOUSING I'\'CE:>iTIYES CO:\"TRIBUTIONS TO AFFORDABLE HOUSI:>iG PROPERTIES
OR DEVELOPMEl'iTS
Name of Development:
Development Location:
(At a minimum provide the adtires& asstgned by the Urulea Stale's Postal. Service, including ~ ~ number, Sllfft ~ and city, or iftbe address has not ret
been assigned. prm:i<kthe ~ name, closest designated inkfiection and city.)
Name of City or County Government
TIle referenced Local Government has an on-going and cunent process for providing contributiollS to
affordable housing propenies or developments.
CERTIFICATIO:>i
I certify that tbe above iuformation is true and canecl.
SignaIl1l'e
Print or Type Name
Prim or Type Tirle
This cenificationmust be signed by the chief appointed official (staff) responsible for issues related to
this incentive. '.Iayor. City Manager. County !\lanager/Administrator!Coordinator, or Chairperson of
the City CounciJiConnmssion or Chairperson of the Board of County Commissioners. Other
signatories are not acceptable. Zero points will be awarded. Signatory must be a representative of the
local go\'enunent that has enacted the incentive. For plUI)Qses of this fOlTIl only, if a Developlllellt is
located withir] a nllUlicipality but the incentive is not available in the city. Applicant may nse county
incentive. For example. if a Development is located in a tom] which does not have impaet fee
requir'ements but the Corlllty has snch requir'ements and they have a reduction or waiwr of these fees
for affordable honsirlg, the Applicant may submit a properly executed Local Government Verification
of Affordable Housing Incentives Form frolll the county.
TIle Applicant will not receiw credit for this incentive and the Application will fail tbl"eshold if the
certification contains conections or 'white-ont' or if the certification is scanned, imaged, altered. or
retyped. The certification may be photocopied.
UAI016 (Rev_ 5-09)
(.ry-tS.0C4(IXa):67..:'lOO3(]Xai-F_Ii.C
Exhibit
Agenda Item NO.1 OB
May 12, 2009
Page 33 of 36
2009 L":'IIIVERSAL CYCLE - LOCAL GOVER..'\~IE:'IIT VERIFICATION OF AFFORDABLE
HOUSING INCE:\'TIVES MODIFICATIO:\' OF FEE REQUIREMENTS FOR AFFORDABLE
HOUSL'iG PROPERTIES OR DEVELOP:\IE2Io.S
Name of Development:
Development Location:
(At a minimum. provide the- address assigned by ~ united States Postal Sen-ice. including the addJ"ess m.u:nber, ~t IWIr and city, or if the address has not yet
httn assignrd provide the- street.aame, closest designated intersection and city.)
Name of City or County Govennnent:
TIle referenced Local Gover1l1l1ent CtllTeutly makes available to affordable housing propenies or
developments the modification of fee requiremeuts, including a reduction or waiver of fees and alte111ative
methods of fee payment.
CERTIFICATION
I cenify that the above information is hue and correct.
Signamre
Pr'i1l1 or Type Name
Print or Type Title
TIus cenification mnst be signed by the chief appointed official (staff) responsible for issues related to
this incentive. Mayor, City Manager, County Manager/Administrator/Coordinator, or Chairperson of
the City CounciVComllussion or Chauperson of the Board of County C01l11l1issioners. Other
signatories are not acceptable. Zero points will be awarded. Signatory must be a representative of the
local gove11l1l1ent that has enacted the incentive. For pmposes of this form only. if a Development is
located \\ithin a municipality but the ince11live is not available in the city. Applicant may use county
urcentive. For example. if a Development is located in a town which does not have impact fee
requu'ements but tlle county has such requirements and they have a reduction or waiver of these fees
for affordable housing, the Applicant may submit a properly executed Local Govenmlent Velification
of Affordable Housing Incentives Form from the county.
TIle Applicant will not receive eredit for tlus incentive and The Application will fail threshold if the
cenification contains conections or 'white-out' or if the cenification is scal1lled, imaged. altered, or
retyped. The certification may be photocopied.
UAlO16 (Rev. 5-()9)
67-4S.clO4(lXa): 6i-2LOOJ(I)la:k fAC.
Exlribit
Agenda Item NO.1 OB
May 12, 2009
Page 34 of 36
2009 L",.VERSAL CYCLE ~ LOCAL GOVER....1\IE:\'T VERIFICATIO:\' OF AFFORDABLE
HOUSNG NCEXTIVES IMPACT OF POLICIES, ORDIXA.'l/CES, REGULATIO'\'S, OR PLA_"
PROnSIOXS OX COST OF AFFORDABLE HOUSNG PROPERTIES OR DEVELOPI\IENTS
Name ofDevelopmellt:
Development Location:
(At a Ill1I1imunL provide the' address assigned bytht- United States Posu1 Ser\"i~. including the address nl.l1Ilber, strffin.ame and city, OJ" if the ~5 b2s not yet
~ a!>SignM. pIO\ide the street ~_ d~st des:ignato::! imersection and city.)
Name ofCit)' or County Government:
The referenced Local GavemIllent clUTeutiy has a process, established by ordinance. resolution. plan. or policy,
that requires consideration of the impact of proposed policies. orclinances. regulations. or plall provisions Oil the
cost of affordable housing prior to adoption of ,o;uch policies. ordinances. regulations. or plan provisions.
CERTIFICATION
I certify that the above infonnation is true and conect.
Sign3hIre
Print or TYl'e Name
Print or Type Title
TIlis cenification musr be signed by the chief appointed offieial (staff) responsible for issues related to
tIllS incentive. Mayor. City Manager. County Manager/".dministrator/Coordinator. or Chairperson of
the City COllllcillConmllssion or Chairperson of the Board of County Commissioners. Orher
signatories are not acceptable. Zero points will be awarded. Signatory n1tIst be a representative of the
local goven1111ent that has enacted the incentive. For plllvoses of tillS fOl111 only. if a Development is
located within a mlllllcipality but the incentive is not available in the city. Applicant may use county
incentive. For example. if a Development is located in a to\\1l which does not have irllpact fee
requiremellls but the county has such requirements and they have a reduction or waiver of these fees
for affordable housing. the Applicalll may submit a properly executed Local Gove11l1l1ent Verification
of Affordable Housing Incemives Fonn fi'om the COllllty.
The Applicant will not receive credit for this incentive and the Application will fail threshold if the
cenificRtion contains conections or 'white-out' or if the cenificatlon is scanned. imaged. altered. or
retyped. The cenificarion may be phOTOcopied.
UAI016 (R~v_ 5--09)
6'-4SOC4{I)(a),67-2]_OOJ(I)::~)_FAC
Exlribit
Agenda Item NO.1 OB
May 12, 2009
Page 35 of 36
2009 U~IVERSAL CYCLE - COl\U.flTMENT TO DEFER DEVELOPER FEE
commits to defer up to
(Name ofDe\'eloper)
$
of its Developer fee to offset any fimding shOltfall \1lltil the closing
of permanent fmancing for
(Name ofDe\'elopmenl)
Additionally, the Developer identified above commits to defer up to $
to
fill any fimding shOltfall after closing of pelmanent financing for the Development identified
above.
I,
, the undersigned, certify that I
(Print or Type Name)
have the authOlity to make this cormuitment on behalf ofthe above-named Developer.
Signature
NOTE:
Ifthe proposed Development will have more than one Developer and the
Developers are committing to defer some or all of the Developer fee, each
Developer must complete and provide a Commitment to Defer Developer
Fee form reflecting the pOltion of the Developer fee it is defening.
If this ceTtification contains cOTrections or 'white-ant', or if it is scanned, imaged, altered, or
retyped, the Application will fail to meet threshold. The cettificationlTlay be photocopied.
UAlO16 (Rev 5-09)
67--48.0C4(IXa);6i'-21,OO3(1Xa).FAG
Exlribit
Page 1 of 1
Agenda Item NO.1 08
May 12, 2009
Page 36 of 36
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
Item Number:
10B
Item Summary:
Recommendation that the Board of County Commissioners provide staff direction on whether
to defer impact fees for a proposed 140 un:l affordable rental apartment development located
in Immokalee, Florida. (Marcy Krumbine. Housing & Human Services Director.)
Meeting Date:
5/12/2009 90000 AM
Preparl'd By
Frank Ramsey
SHIP Program Coordinator
Date
Public Services
Housing and Human Services
4/24/2009 2:05:30 PM
Appro\'ed B)'
Marcy Krumbine
Public Services
Director
Date
Housing & Human Services
4/24/20096:54 PM
Approved By
Colleen Greene
Assistant County Attorner
Date
County Attorney
County Attorney Office
4/28/20099:15 AM
Appron>{) III
Amy Patterson
Community Development &
Environmental Services
Impact Fee Manager
Date
Financial Admin. & Housing
4/28/200911:41 AM
Approved B)'
Kathy Carpenter
Executive Secretary
Date
Public Services
Public Servi:::es Admin.
4/28/2009 2:56 PM
Apprond By
Marla Ramsey
Public Services
Public Services Administrator
Date
Public Services Admin.
4/28/20094:51 PM
Approved By
OMB Coordinator
OMS Coordinator
Date
County Manager's Office
Office of Management & Budget
4129/200912:26 PM
Approved B)'
Sherry Pryor
County Manager's Office
Management & Budget Analyst
Date
Office of Management & Budget
4/30/20098:44 AM
Approved By
Jeff Klatzkow
Ccunty Attorney
County Attorney Office
Date
County Attorney
4/30/20094:13 PM
Approwd By
Leo E. Ochs, Jr.
Deputy County Manager
Date
Soard of County
Commissioners
County Manager's Office
5/4/20099:22 AM
file:l/C:\AgendaTcst\ExpOli\ I 29-l'vlay%20 12,%202009\ 1 0.%20COUNTY%20l'vlANAG ER %... 5/6/2009