HOUSING REPAIR PROGRAM APPLICATION

HOUSING REPAIR PROGRAM APPLICATION City of Deerfield Beach Planning and Growth Management Community Development Division 533 South Dixie Highway, Suite 101 Deerfield Beach, Florida 33441 (954) 480-6420

Dear Housing Repair Applicant: Enclosed is information and application regarding the City s Housing Repair Programs. The City offers its residents three (3) home repair programs: 1. Home Repair Program utilizes State Housing Initiative Partnership (SHIP), Community Development Block Grant (CDBG), Disaster Recovery Initiative (DRI) and any other designated housing Federal or State funds to provide financial assistance to owner-occupied homeowners, who reside within the City limits of Deerfield Beach. The Home Repair Program assists the homeowner with repairs that may be detrimental to the homeowner s safety, repairs that eliminate infiltration of outside elements, repairs that eliminate architectural barriers for the elderly and/or handicapped, repairs that prevent further deterioration to the home in addition to eliminating blighting influences in the neighborhood. Maximum home repair assistance available is up to $50,000* 2. Emergency Roof Repair Program utilizes SHIP, CDBG, DRI and any other designated housing Federal or State funds to make emergency repairs that are an imminent threat to the owner-occupied resident s health, safety and/or welfare. Inclusion in the Emergency Repair Program shall not exclude applicant from participation in the City s Home Repair Program. Emergency repairs may include but are not limited to roof replacement, plumbing and electrical repairs. This Program is available only to owner-occupied homeowners whose income does not exceed 80% of the median income. Maximum emergency roof repair assistance available is up to $10,000.00 The above repair programs are available to City of Deerfield Beach homeowners who live in their properties. Participation in any of the above programs will result in a five (5) year deferred payment mortgage recorded against the property. If the homeowner continues to live in the property for five (5) consecutive years and does not refinance, sell, rent, lease or transfer ownership of the property, the City s mortgage will be satisfied at the end of the five (5) year period, thereby releasing the homeowner from further obligation to the City. The Housing Repair Application must be completed entirely, dated, signed by the applicant and coapplicant (where applicable). To expedite the processing of your application, please make sure all applicable documentation for your household is attached at the time of submission. Funding for the Housing Repair Programs is made possible through State Housing Initiative Partnership (SHIP), Community Development Block Grant (CDBG) and Disaster Recovery Initiative (DRI) funds as well as other State and Federal funds that are received through the City of Deerfield Beach, Planning and Growth Management Department, Community Development Division, 533 S. Dixie Highway, Suite 101, Deerfield Beach, FL 33441 If you have any additional questions, please call Debra Chatman, Community Development Coordinator at (954) 422-5843. *depending on availability of funds at time of application approval.

Frequently Asked Questions 1. What is the Home Rehabilitation Program? The City of Deerfield Beach, Florida, receives State Housing Initiative Partnership (SHIP), Community Development Block Grant (CDBG), Disaster Recovery Initiative (DRI) and other designated housing Federal and State funds to provide financial assistance to qualified owner-occupied homeowners who reside within the City limits of Deerfield Beach to assist with making repairs to their home. 2. Who Qualifies For the Housing Rehabilitation Program? If your home is located within the City limits of Deerfield Beach, you are currently living in your home and your gross household income is within the guidelines for your family size (see chart below) you may qualify for a five (5) year deferred payment loan to make repairs to your home. 3. Who Determines What Repairs Can Be Made to My Home? The Community Development Inspector will make an assessment of the repairs to be made to your home. Repairs are reviewed with the homeowner and are made according to priority as listed below: HIGH PRIORITY LOW PRIORITY OPTIONAL REPAIRS Site Work: Foundation & Interior doors and locks Central A/C demolition Roof and related wood work Finishes: baseboard, interior painting Sidewalk/Driveway (if a code violation or safety hazard) Residential Plumbing Window sills Tree pruning/removal Electrical Exterior Painting Landscaping Exterior doors and windows Interior wall & ceiling repairs Kitchen & Bath floors Appliance replacement Kitchen cabinets Bath Vanity House numbers Architectural barriers 4. Will I be Able to Live In My Home While Repairs Are Being Made? Relocation will be reviewed on a case-by-case basis. However, the homeowner is responsible for moving furniture, appliances and window treatments in order for the contractor to make the necessary repairs.

Please check the program(s) you are applying for: Housing Repair Program Application City of Deerfield Beach Home Housing Repair Emergency Repair DRI (Hurricane Repair/Mitigation) Applicant Information (Head of Household) Please Print: Applicant Name: Mailing Address: Home Phone: ( ) Cellular Phone:( ) E-Mail Address: Social Security Number: - - Date of Birth: / / Month Day Year 1 st Employer Name: Mailing Address: Employer Phone Number: ( ) Extension: Gross Salary* (Annual, before deductions): 2 nd Employer Name: Mailing Address: Employer Phone Number: ( ) Extension: Gross Salary* (Annual, before deductions): Co-Applicant Information Co-Applicant Name: Mailing Address: Home Phone: ( ) Cellular Phone:( ) E-Mail Address: Social Security Number: - - Date of Birth: / / Month Day Year 1 st Employer Name: Address: Employer Phone Number: ( ) Extension: Gross Salary* (Annual, before deductions): 2 nd Employer Name: Mailing Address: Employer Phone Number: ( ) Extension: Gross Salary* (Annual, before deductions):

LIST ALL HOUSEHOLD MEMBERS (include applicant & co-applicant) Name Social Security No. Date of Birth Income Source Gross Income (monthly, weekly, annual) APPLICANT AND CO-APPLICANT ASSETS Do you own vacant land or another home? Yes No If yes, please provide address: What is the amount of rent you receive from the property $ Did you co-sign on another mortgage? Yes No Mortgage Company name & address: What type of bank accounts do you have?: Checking Savings CD s IRA, 401K, Money Market, Other What is/are the name(s) of your bank(s)? (Make sure you provide 3 current bank/financial statements for all accounts) Assets include, but are not limited to cash held in savings and/or checking accounts, safe deposit boxes, homes, etc.; trust funds (revocable trusts); equity in real estate and other capital investments; stocks, bonds, treasury bills, certificates of deposit, money market and other investment accounts; IRA Keogh and similar accounts; retirement and pension funds; cash value of life insurance policies available to the individual before death; mortgage or deed of trust; lump sum receipts (i.e. lottery winnings, inheritances, victims restitution, insurance claims or settlements, etc.); and personal property held as an investment (i.e. gem or coin collection, paintings, antique cars, etc.). I/We hereby state that the combined value of my/our assets (check one): Do not exceed $5,000 Exceed $5,000 Applicant Signature Print Applicant Name Date Co-Applicant Signature Print Applicant Name Date Note: All income and assets information will be verified

HOUSING REPAIR PROGRAM CERTIFICATION City of Deerfield Beach CERTIFICATION I/We hereby certify that I/we am/are the applicant(s) and that to the best of my/our knowledge all information provided in this application is true and correct. I/We understand and agree that this loan is being made to assist in rehabilitating my/our home and that the loan is not assumable and that it is not intended to be for my/our profit. I/We understand the Community Development Division is required by Federal Regulation to inform me/us that any rehabilitation loan obtained requires the purchase of flood insurance by property owners who are being assisted by Federal programs or by federally supervised, regulated, or insured agencies or institutions in the acquisition or improvement of land or facilities located or to be located in identified areas having special flood hazards identified by the Secretary of Housing and Urban Development under the authority of Public Law 93-234 (The Flood Disaster Act of 1973) must be insured. In addition, I also agree to comply with the appropriate statement below: If insurance is not in existence, a policy must be ordered covering your structure for an amount that includes this loan balance and the 1 st mortgage, if applicable, showing the City of Deerfield Beach as the mortgagee or additional mortgagee as long as the City s mortgage exists. If there is a policy currently in existence on this property, the coverage must be increased to include this loan balance and the City of Deerfield Beach added as the second mortgagee as long as the City s mortgage exists. If there is an existing policy written for the maximum coverage for this property, endorse the City of Deerfield Beach as the second mortgagee as long as the City s mortgage exists. I acknowledge and understand the City of Deerfield Beach, though not a party to this Agreement, must gratuitously act as an Escrow Agent for the disbursement of SHIP, CDBG, and/or other Federal or State housing rehabilitation funds and as quality inspector to assure that the work is performed in accordance with the Bid Specifications and workmanship for the trade. I/We acknowledge being directly involved in the preparation of the Bid Specifications and has received a copy of the Bid Specifications and are in agreement with the proposed work. Homeowner Signature Date Homeowner Signature Date

AUTHORIZATION FOR THE RELEASE OF INFORMATION This authorization hereby gives the City of Deerfield Beach Community Development Division or its designated agent the right to request/verify all information from any persons; company or firm provided in my/our Housing Repair Application necessary for determining my/our eligibility can be requested. I/We agree to have no claim for defamation, violation of privacy or other claims against any person or firms or corporation by reasons of any statement or information released to the City of Deerfield Beach Community Development Division. I/We the undersigned, hereby authorize the City of Deerfield Beach Community Development Division or its designated agent to obtain and receive all records and information pertaining to, but not limited to my employment, cash held in checking/savings accounts, stocks, bonds, Certificates of Deposit (CD), Individual Retirement Accounts (IRA), interest dividends, etc.; payments from Social Security, annuities, insurance policies, retirement funds, pension, disability or death benefits; unemployment, disability and/or worker s compensation; welfare assistance; net income from the operation of a business; and alimony and/or child support payments, etc. from all persons, companies or firms holding or having access to such information for the purposes of verifying information provided in my/our Housing Repair Application, to determine my/our eligibility for home repair assistance. I/We authorize the City of Deerfield Beach Community Development Division to obtain or exchange such information as it may require in connection with this application. Penalty for false or fraudulent statement: I/We understand that under U.S.C. Title 18, Section 1001 any untruthful or deliberately misleading statement made on this application or use of any untruthful or misleading statement on a document supporting this application, can result in prosecution under Federal law, and that I can be fined not more than $10,000 and/or imprisoned for not more than five (5) years if found guilty. Homeowner Signature Date Homeowner Signature Date

APPLICATION CHECK LIST City of Deerfield Beach The below listed documents must be included with the City of Deerfield Beach Housing Repair Application. Please make sure the applicable documents are included with your application. Any missing information will result in your application being returned and not processed for assistance. LEGAL DOCUMENTS: Copy of Deed to home to be repaired (must be in the name of the person applying for assistance) Current mortgage statement(s) Current Homeowner s and Flood Insurance Certificate Copies of Birth Certificates of all household members or immigration cards Copy of Social Security Cards for all household members Copy of Marriage license or Divorce Decree (if applicable) Copy of Death Certificate of Spouse (if applicable) Copy of Court Order for Child Support Copy of Photo I.D. for Head(s) of Household PROOF OF INCOME (all income sources will be 3 RD party verified) Four (4) current payroll stubs for all household members 18 years old and over Three (3) current bank statements for all bank account Current Benefit Letter from Social Security/SSI Current Pension Benefit Letter Current AFDC/Relative Caregiver Benefit Letter Copy of current 2 years Income Tax Return forms with w-2 s attached for all household members 18 years old and over List repairs needed for your home on the enclosed sheet The applicant understands that the intent of this application is only for purposes of pre-qualifying. It does not guarantee acceptance or approval and no commitment is hereby made on part of either party.

The intent of this application is only to pre-qualify the prospective applicant(s). It does not guarantee acceptance or approval and no commitment is hereby made on the part of either party. Housing Repair Application and Qualification Information 1. Applicant must currently be living in and be the owner of, a single-family home, townhouse, condominium or villa. 2. The home must be in need of repairs that will (1) eliminate further deterioration (2) prevent or eliminate conditions which are detrimental to family safety and welfare and (3) prevent or eliminate blighting influences in the neighborhood. 3. Complete applications are received in the Community Development Division and are processed on a first-come, first-qualify basis. To expedite the processing of your application, please make sure all applicable documentation is attached to your application at the time of submission. Applicant s income information is 3 rd party verified for final program participation approval. 4. Applicants are notified by mail if their application has been approved or denied for housing repair assistance. All applicants who are preliminary approved must attend a Housing Repair Workshop (date and time will be included in preliminary approval notice). 5. If home is eligible for repairs, Community Development Inspector will make an appointment with the homeowner to conduct an extensive inspection of the repairs needed with the assistance of the homeowner. Homeowner must also provide a list of repairs that are needed and submit along with application. 6. Repairs for the home are submitted to General Contractors on the City s preferred contractor s list and a Pre-bid conference is held at the home being considered for repairs; to which the homeowner must be present. 7. In the presence of the homeowner, sealed bids submitted by General Contractors are opened and the apparent low bid is forwarded to the City Commission for funding approval. 8. Construction Contract is executed between the Homeowner and Contractor and a Notice to Proceed is issued to begin making repairs. Contractor is required to obtain applicable permits and complete the repairs by the dated specified in the Notice to Proceed. HOUSEHOLD INCOME* Family 50% 80% 120% Family 50% 80% 120% size size 1 $26,800 $42,850 $64,320 5 $41,300 $66,100 $99,120 2 $30,600 $48,950 $73,440 6 $44,350 $71,000 $106,440 3 $34,450 $55,100 $82,680 7 $47,450 $75,900 $113,880 4 $38,250 $61,200 $91,800 8 $50,500 $80,800 $121,200 9. Maximum Appraised value of home to be repaired cannot exceed $331,579 *Income guidelines and maximum home appraised value subject to change without notice

PLEASE LIST REPAIRS THAT YOU NEED MADE TO YOUR HOME City of Deerfield Beach