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H A C S A M E M O R A N D U M TO: PRESENTED BY: AGENDA ITEM TITLE: HACSA Board of Commissioners Jacob Fox, Executive Director ORDER In the Matter of In the Matter of Adopting the Significant Amendment to the Annual Plan regarding the 2015 Capital Grant Fund AGENDA DATE: May 17th, 2016 I. PROPOSED MOTION: IT IS MOVED THAT T H E S I G N I F I C A N T A M E N D M E N T T O T H E A N N U A L P L A N R E G A R D I N G T H E 2 0 1 5 C A P I T A L G R A N T F U N D I S A D O P T E D II. AGENDA ITEM/SUMMARY: Board approval is requested for the Adoption of the Significant Amendment to the Annual Plan regarding the 2015 Capital Grant Fund III. BACKGROUND: A. Introduction / Analysis HACSA is required to submit a Significant Amendment to its Annual Plan for immediate funding of the following projects: 1) Parkview Terrace roof system repairs were budgeted in the 2014 Capital Fund Grant. There were not enough funds in the 2014 grant, so the roof replacement had to be added to the 2015 grant. During the planning phases, several roofing experts were called to the site to evaluate the roof. Moisture testing found significant water retention in the insulation of the roof and the roof was classified as failing and in need of a full replacement. HUD field office in Portland determined that the budgeted project Parkview Terrace roof system repairs did not qualify as a roof replacement and a significant amendment is needed.

2) Riverview Terrace elevator system has an unexpected unbudgeted expenditure. Significant Amendment is required to fund the emergency repairs. B. Recommendation. Approval of the proposed Motion. C. Timing. Upon approval of the Order, the Executive Director will execute the necessary documents. IV. IMPLEMENTATION/FOLLOW-UP: Same as Item III. C. above. V. ATTACHMENTS: Exhibit A Annual Capital Fund Plan Form HUD 50075.1 Exhibit B Five Year Capital Fund Plan Form HUD 50075.2 Exhibit C Revised Annual Capital Fund Plan Form HUD 50075.1 Exhibit D Revised Five Year Capital Fund Plan Form HUD 50075.2

IN THE BOARD OF COMMISSIONERS OF THE HOUSING AND COMMUNITY SERVICES AGENCY OF LANE COUNTY, OREGON ORDER NO. )IN THE MATTER OF ADOPTING THE )SIGNIFICANT AMENDMENT TO HACSA s )ANNUAL PLAN REGARDING THE 2015 CAPITAL )FUND GRANT WHEREAS, it is necessary for the Board to adopt a significant amendment to HACSA s Annual Plan regarding the 2015 Capital Fund Grant for the Housing And Community Services Agency of Lane County, Oregon; and WHEREAS, a public hearing to receive comments on the amendment was held on April 6, 2016; and WHEREAS, no comments were received; and WHEREAS, the HACSA Executive Director has recommended approval of the proposed significant amendment to HACSA s Annual Plan regarding the 2015 Capital Fund Grant; and WHEREAS, the Board having fully considered the Executive Director s recommendation, NOW, THEREFORE, IT IS HEREBY ORDERED, that the significant amendment to HACSA s Annual Plan regarding the 2015 Capital Fund Grant is hereby adopted. DATED this day of, 2016 Chairperson, HACSA Board of Commissioners IN THE MATTER OF ADOPTING THE SIGNIFICANT AMENDMENT TO HACSA s ANNUAL PLAN REGARDING THE 2015 CAPITAL FUND GRANT

Annual Statement/Performance and Evaluation Report U.S. Department of Housing and Urban Development Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital Fund Financing Program OMB No. 2577-0226 Expires 06/30/2017 Part I: Summary PHA Name: Housing and Community Services Agency of Lane County (HACSA) Grant Type and Number Capital Fund Program Grant No: OR16P006 501 15 Replacement Housing Factor Grant No: Date of CFFP: Type of Grant Original Annual Statement Reserve for Disasters/Emergencies Revised Annual Statement (revision no: ) Performance and Evaluation Report for Period Ending: Final Performance and Evaluation Report FFY of Grant: 2015 FFY of Grant Approval: 2015 Line Summary by Development Account Total Total Actual Cost 1 Original Revised 2 Obligated Expended 1 Total non-cfp Funds 0 2 1406 Operations (may not exceed 20% of line 21) 3 168,000.00 3 1408 Management Improvements 15,000.00 4 1410 Administration (may not exceed 10% of line 21) 95,268.00 5 1411 Audit 2,000.00 6 1415 Liquidated Damages 0 7 1430 Fees and Costs/ Architect/ GPNA 65,000.00 8 1440 Site Acquisition 0 9 1450 Site Improvement 97,867.50 10 1460 Dwelling Structures 402,700.00 11 1465.1 Dwelling Equipment Nonexpendable 64,210.50 12 1470 Non-dwelling Structures 0 13 1475 Non-dwelling Equipment 10,000.00 14 1485 Demolition 0 15 1492 Moving to Work Demonstration 0 16 1495.1 Relocation Costs 5,000.00 17 1499 Development Activities 4 0 1 To be completed for the Performance and Evaluation Report. 2 To be completed for the Performance and Evaluation Report or a Revised Annual Statement. 3 PHAs with under 250 units in management may use 100% of CFP Grants for operations. 4 RHF funds shall be included here. Page1 form HUD-50075.1 (07/2014)

Annual Statement/Performance and Evaluation Report U.S. Department of Housing and Urban Development Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital Fund Financing Program OMB No. 2577-0226 Expires 06/30/2017 Part I: Summary PHA Name: Housing and Community Services Agency of Lane County (HACSA) Type of Grant Grant Type and Number Capital Fund Program Grant No: OR16P006 501 15 Replacement Housing Factor Grant No: Date of CFFP: FFY of Grant:2015 FFY of Grant Approval: 2015 Original Annual Statement Reserve for Disasters/Emergencies Revised Annual Statement (revision no: ) Performance and Evaluation Report for Period Ending: Final Performance and Evaluation Report Line Summary by Development Account Total Total Actual Cost 1 Original Revised 2 Obligated Expended 18a 1501 Collateralization or Debt Service paid by the PHA 0 18ba 9000 Collateralization or Debt Service paid Via System of Direct 0 Payment 19 1502 Contingency (may not exceed 8% of line 20) 27,666.00 20 Amount of Annual Grant:: (sum of lines 2-19) $952,712.00 21 Amount of line 20 Related to LBP Activities 0 22 Amount of line 20 Related to Section 504 Activities 0 23 Amount of line 20 Related to Security - Soft Costs 0 24 Amount of line 20 Related to Security - Hard Costs 0 25 Amount of line 20 Related to Energy Conservation Measures 156,410.50 Signature of Executive Director Date Signature of Public Housing Director Date 1 To be completed for the Performance and Evaluation Report. 2 To be completed for the Performance and Evaluation Report or a Revised Annual Statement. 3 PHAs with under 250 units in management may use 100% of CFP Grants for operations. 4 RHF funds shall be included here. Page2 form HUD-50075.1 (07/2014)

Annual Statement/Performance and Evaluation Report U.S. Department of Housing and Urban Development Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital Fund Financing Program OMB No. 2577-0226 Expires 06/30/2017 Part II: Supporting Pages PHA Name: Housing and Community Services Agency of Lane County (HACSA) Grant Type and Number Capital Fund Program Grant No: OR16P006 501 15 CFFP (Yes/ No): Replacement Housing Factor Grant No: Federal FFY of Grant: 2015 Development Number Name/PHA-Wide Activities AMP 200 McKenzie Village AMP 200 McKenzie Village AMP 200 McKenzie Village AMP200 McKenzie Village AMP 400 Parkview Terrace AMP 500 Lindeborg Place AMP 500 Lindeborg Place AMP 500 Lindeborg Place AMP 500 Lindeborg Place AMP 500 Veneta Villa General Description of Major Work Categories Development Account No. Quantity Total Total Actual Cost Status of Work Original Revised 1 Funds Obligated 2 Roof Replacements 1460 24 60,000.00 Fencing Replacement 1450 3250 lf 65,000.00 Water Heater Replacement 1465 27 24,210.50 Ext. Door and Lock Replacement 1460 27 70,500.00 AMP 200 TOTAL 291,710.50 Screen Door Replacement 1460 150 70,000.00 AMP 400 TOTAL 70,000.00 Heater Valves/ Radiator Flush 1465 40 40,000.00 Balcony Deck Seal 1460 1 2,000.00 Bath Upgrades 1460 2 8,000.00 Apartment Lighting 1460 40 25,200.00 Asphalt Overlay 1450 1 32,867.50 AMP 500 TOTAL 108,067.50 Funds Expended 2 Page3 form HUD-50075.1 (07/2014)

AMP 600 Cresview Villa AMP 600 Riverview Terrace Windows/ Patio Doors/ Abatement 1460 34 107,000.00 Balcony Deck/ Rail Repair 1460 60 60,000.00 AMP 600 TOTAL 167,000.00 WORK ITEMS TOTAL 564,778.00 1 To be completed for the Performance and Evaluation Report or a Revised Annual Statement. 2 To be completed for the Performance and Evaluation Report. Page4 form HUD-50075.1 (07/2014)

Part II: Supporting Pages PHA Name: Housing and Community Services Agency of Lane County (HACSA) Grant Type and Number Capital Fund Program Grant No: OR16P006 501 15 CFFP (Yes/ No): Replacement Housing Factor Grant No: Federal FFY of Grant: 2015 Development Number Name/PHA-Wide Activities General Description of Major Work Categories Development Account No. Other Architect 1430 45,000.00 Audit 1411 2,000.00 Sundries for support work 1430 10,000.00 GPNA 1430 10,000.00 Relocation 1495 5,000.00 Contingency 1502 27,666.00 Management Improvements 1408 15,000.00 PHA Wide Non-Dwelling Structures & Equipment- Computer & related hardware Quantity Total Total Actual Cost Status of Work 1475 10,000.00 Grant Administration 1410 95,268.00 Transfer 1406 168,000.00 Other Total 387,934.00 TOTAL CAPAITAL GRANT 952,712.00 Original Revised 1 Funds Obligated 2 Funds Expended 2 Page5 form HUD-50075.1 (07/2014)

Annual Statement/Performance and Evaluation Report U.S. Department of Housing and Urban Development Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital Fund Financing Program OMB No. 2577-0226 Expires 06/30/2017 Part III: Implementation Schedule for Capital Fund Financing Program PHA Name: Federal FFY of Grant: Development Number Name/PHA-Wide Activities AMP 200 McKenzie Village AMP 200 McKenzie Village AMP 200 McKenzie Village AMP200 McKenzie Village AMP 400 Parkview Terrace AMP 500 Lindeborg Place AMP 500 Lindeborg Place AMP 500 Lindeborg Place AMP 500 Lindeborg Place AMP 500 Veneta Villa AMP 600 Cresview Villa AMP 600 Riverview Terrace All Fund Obligated (Quarter Ending Date) Original Obligation End Date Actual Obligation End Date 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 04/12/2017 04/12/19 Original Expenditure End Date All Funds Expended (Quarter Ending Date) Actual Expenditure End Date Reasons for Revised Target Dates 1 1 Obligation and expenditure end dated can only be revised with HUD approval pursuant to Section 9j of the U.S. Housing Act of 1937, as amended. Page6 form HUD-50075.1 (07/2014)

Part I: Summary PHA Name/Number: Housing And Community Services Agency of Lane County (HACSA) OR006 Locality (City/County & State) Eugene/Springfield, Lane County, Oregon Original 5-Year Plan Revision No: A. Development Number and Name Work Statement for Year 1 FFY 15 Work Statement for Year 2 FFY 16 Work Statement for Year 3 FFY 17 Work Statement for Year 4 FFY 18 Work Statement for Year 5 FFY 19 B. Physical Improvements Annual Statement 593,600.00 593,600.00 593,600.00 593,600.00 Subtotal C. Management Improvements 15,000.00 15,000.00 15,000.00 15,000.00 D. PHA-Wide Non-dwelling 10,000.00 10,000.00 10,000.00 10,000.00 Structures and Equipment E. Administration 95,268.00 95,268.00 95,268.00 95,268.00 F. Other 70,844.00 70,844.00 70,844.00 70,844.00 G. Operations 168,00000 168,000.00 168,000.00 168,000.00 H. Demolition 0.00 0.00 0.00 0.00 I. Development 0.00 0.00 0.00 0.00 J. Capital Fund Financing 0.00 0.00 0.00 0.00 Debt Service K. Total CFP Funds 0.00 0.00 0.00 0.00 L. Total Non-CFP Funds 0.00 0.00 0.00 0.00 M. Grand Total 965,384.00 952,712.00 952,712.00 952,712.00 Page 1 of 8 form HUD-50075.2 (4/2008)

Part I: Summary (Continuation) PHA Name/Number: Housing And Community Services Agency of Lane County (HACSA) OR006 Development Number and Work A. Name: Statement for Year 1 FFY 2015 Locality (City/County & State) Eugene/Springfield, Lane County, Oregon Work Statement for Year 2 FFY 2016 Work Statement for Year 3 FFY 2017 Original 5-Year Plan Work Statement for Year 4 FFY 2018 AMP 100 Laurelwood Homes Annual 28,500.00 0.00 17,500.00 0.00 Revision No: Village Statement 131,100.00 278,600.00 250,600.00 100,000.00 AMP 200 Pengra Court 0.00 5,000.00 170,000.00 50,008.00 AMP 200 Scattered Sites 0.00 0.00 0.00 45,000.00 AMP 300 Scattered Sites 67,132.50 0.00 0.00 30,000.00 AMP 300 Maplewood 188,000.00 0.00 36,500.00 165,592.00 Meadows AMP 400 Parkview Terrace 18,000.00 218,000.00 25,500.00 0.00 AMP 500 Lindeborg Place 0.00 2,000.00 0.00 0.00 AMP 500 Veneta Villa 0.00 0.00 0.00 0.00 AMP 500 Veneta Scattered 32,867.50 0.00 0.00 0.00 Sites AMP 600 Cresview Villa 28,000.00 0.00 0.00 60,000.00 AMP 600 Riverview Terrace 100,000.00 90,000.00 93,500.00 143,000.00 TOTAL 593,600.00 593,600.00 593,600.00 593,600.00 Work Statement for Year 5 FFY 2019 Page 2 of 8 form HUD-50075.2 (4/2008)

Part II: Supporting Pages Physical Needs Work Statement(s) Work Statement for Year 1 FFY 2015 Development Number/Name General Description of Major Work Categories See AMP 100 Laurelwood Chain Link Fences Annual AMP 100 Laurelwood 3-4 bdrm units- range, refer, kit fan, bath fan, 7 bb heaters each Statement Village Duplex & Admin Roofs Village Paint FV Admin & Maint Bldgs Village Phase 2- Fencing Village Asbestos Flooring Abatement/Replacement AMP 300 Scattered Sites Fence Replacements AMP 300 Maplewood Meadows Windows AMP 400 Parkview Terrace Balcony Deck Sealing AMP 500 Veneta Scattered Site Asphalt Seal Coat/Stripe Work Statement for Year 2 FFY 2016 Quantity Development Number/Name General Description of Major Work Categories 945 LF 21,000.00 AMP 600 Cresview Villa Electrical Upgrade 3 7,500.00 AMP 600 Riverview Terrace: Seismic Upgrade to Building 13 duplexes 38,320.00 & Admin & Main Shop 1 12,000.00 1835 LF 40,780.00 8 40,000.00 13 67,132.50 38 units 188,000.00 1 18,000 1 32,867.50 Work Statement for Year 2 FFY 2016 Quantity 14 28,000.00 1 100,000.00 Subtotal of $593,600.00 Page 3 of 8 form HUD-50075.2 (4/2008)

Part II: Supporting Pages Physical Needs Work Statement(s) Work Statement for Year 1 FFY 2015 See Annual Statement Development Number/Name General Description of Major Work Categories Village: Sidewalks, asphalt parking areas & driveways Village: Duplex Roofs Village: Water Heater replacement Village: Kitchen upgrades Village: Sewer Drain Replacements Village: Water System Evaluation/Repairs Village Asbestos Flooring Abatement/Replacement AMP 200 Pengra Court: Sidewalks R&R AMP 400 Parkview Terrace: Balcony Deck Sealing Work Statement for Year 3 FFY 17 Quantity Development Number/Name General Description of Major Work Categories 1530 LF 17,000.00 AMP 400 Parkview Terrace: Roof System Repairs 11 27,223.00 AMP 500 Lindeborg Place: Balcony Deck Repairs 123 111,377.00 AMP 600 Riverview Terrace: Heating Upgrade- DHP 10 50,000.00 1 2,000.00 1 31,000.00 8 40,000.00 1 5,000.00 1 18,000 Work Statement for Year: 3 FFY 17 Quantity 1 200,000.000 1 2,000.00 1 90,000.00 Subtotal of $593,600.00 Page 4 of 8 form HUD-50075.2 (4/2008)

Part II: Supporting Pages Physical Needs Work Statement(s) Work Statement for Year 1 FFY 2015 See Annual Statement Development Number/Name General Description of Major Work Categories AMP 100 Laurelwood: Site Lighting AMP 100 Laurelwood: Replace Wood Fencing Village: Duplex roofs Village: Sidewalks, asphalt parking areas & driveways Village: Water Heater replacement Village: Kitchen upgrades Village: Asbestos Flooring Abatement/Replacement AMP 200 Pengra Court: Weatherization- Windows/Ext doors/heating/laundry fans AMP 200 Pengra Court: Siding Repairs Work Statement for Year 4 FFY 18 Quantity Development Number/Name General Description of Major Work Categories 1 14,000.00 AMP 300 Maplewood Meadows: ADA Kitchen Remodel 140 LF 3,500.00 AMP 300 Maplewood Meadows: Office Remodel 43 70,367.50 AMP 400 Parkview Terrace: Balcony Deck Sealing 1 20,000.00 AMP 400 Parkview Terrace: Mailboxes 22 20,232.50 AMP 600 Riverview Terrace: Mailboxes 20 100,000.00 AMP 600 Riverview Terrace: Heating Upgrade- DHP 8 40,000.00 22 120,000.00 1 50,000.00 Work Statement for Year: 4 FFY 18 Quantity 2 26,500.00 1 10,000.00 1 18,000.00 1 7,500.00 60 3,500.00 1 90,000.00 Subtotal of $593,600.00 Page 5 of 8 form HUD-50075.2 (4/2008)

Part II: Supporting Pages Physical Needs Work Statement(s) Work Statement for Year 1 FFY 2015 See Annual Statement Development Number/Name General Description of Major Work Categories Village: Duplex roofs Village: Kitchen upgrades Village: Asbestos Flooring Abatement/Replacement AMP 200 Pengra Court: Roof Replacement AMP 200 Scattered Sites: Int/Ext Minor Mods AMP 300 Scattered Sites: Int/Ext Minor Mods AMP 300 Maplewood Meadows: Siding Repairs AMP 300 Maplewood Meadows: AMP 600 Cresview Villa: Exterior building paint AMP 600 Riverview Terrace: Building Exterior Elastomeric Coating Work Statement for Year 5 FFY 19 Quantity Development Number/Name General Description of Major Work Categories 1 30,000.00 AMP 600 Riverview Terrace: Roof Replacement 1 30,000.00 8 40,000.00 1 50,008.00 9 45,000.00 5 30,000.00 1 135,592.00 1 30,000.00 1 60,000.00 1 75,000.00 Work Statement for Year: 5 FFY 19 Quantity 1 68,000.00 Page 6 of 8 form HUD-50075.2 (4/2008)

Subtotal of $593,600.00 Part III: Supporting Pages Management Needs Work Statement(s) Work Statement for Work Statement for Year 2 FFY 16 Work Statement for Year 3 FFY 17 Year 1 Development Number/Name Development Number/Name FFY 15 General Description of Major Work Categories General Description of Major Work Categories See Modernization Staff Training 15,000.00 Modernization Staff Training 15,000.00 Annual Equipment (i.e. workstation upgrades, 10,000.00 Equipment (i.e. computers & printers, 10,000.00 Statement communications upgrades, file server) Management Improvements (CNA s, Energy Audits, GPNA) communication upgrades) 3,844.00 Management Improvements (CNA s, Energy Audits, GPNA) 3,844.00 Subtotal of $28,844.00 Subtotal of $28,844.00 Page 7 of 8 form HUD-50075.2 (4/2008)

Part III: Supporting Pages Management Needs Work Statement(s) Work Work Statement for Year 4 Work Statement for Year:5 Statement for FFY 18 FFY 19 Year 1 Development Number/Name Development Number/Name FFY 14 General Description of Major Work Categories General Description of Major Work Categories See Modernization Staff Training 15,000.00 Modernization Staff Training 15,000.00 Annual Equipment (i.e. workstation upgrades, 10,000.00 Equipment (i.e. workstation upgrades, 10,000.00 Statement communications upgrades) Management Improvements (CNA s, Energy Audits, GPNA) communications upgrades, file server) 3,844.00 Management Improvements (CNA s, Energy Audits, GPNA) 3,844.00 Subtotal of $28,844.00 Subtotal of $28,844.00 Page 8 of 8 form HUD-50075.2 (4/2008)

Annual Statement/Performance and Evaluation Report U.S. Department of Housing and Urban Development Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital Fund Financing Program OMB No. 2577-0226 Expires 06/30/2017 Part I: Summary PHA Name: Housing and Community Services Agency of Lane County (HACSA) Grant Type and Number Capital Fund Program Grant No: OR16P006 501 15 Replacement Housing Factor Grant No: Date of CFFP: FFY of Grant: 2015 FFY of Grant Approval: 2015 Type of Grant Original Annual Statement Reserve for Disasters/Emergencies Revised Annual Statement (revision no: 3) Performance and Evaluation Report for Period Ending: Final Performance and Evaluation Report Line Summary by Development Account Total Total Actual Cost 1 Original Revised 2 Obligated Expended 1 Total non-cfp Funds 0 0 0 0 2 1406 Operations (may not exceed 20% of line 21) 3 168,000.00 168,000.00 0 0 3 1408 Management Improvements 15,000.00 15,000.00 0 0 4 1410 Administration (may not exceed 10% of line 21) 95,124.00 95,124.00 0 0 5 1411 Audit 2,000.00 2,000.00 0 0 6 1415 Liquidated Damages 0 0 0 7 1430 Fees and Costs/ Architect/ GPNA 63,750.00 47,750.00 0 0 8 1440 Site Acquisition 0 0 0 9 1450 Site Improvement 66,000.00 6,000.00 0 0 10 1460 Dwelling Structures 429,567.50 531,778.00 0 0 11 1465.1 Dwelling Equipment Nonexpendable 69,210.50 43,000.00 0 0 12 1470 Non-dwelling Structures 0 0 0 0 13 1475 Non-dwelling Equipment 10,000.00 10,000.00 0 0 14 1485 Demolition 0 0 0 0 15 1492 Moving to Work Demonstration 0 0 0 0 16 1495.1 Relocation Costs 5,000.00 5,000.00 0 0 17 1499 Development Activities 4 0 0 0 0 1 To be completed for the Performance and Evaluation Report. 2 To be completed for the Performance and Evaluation Report or a Revised Annual Statement. Annual Statement/Performance and Evaluation Report U.S. Department of Housing and Urban Development Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital Fund Financing Program OMB No. 2577-0226 Page1 form HUD-50075.1 (07/2014)

Part I: Summary PHA Name: Housing and Community Services Agency of Lane County (HACSA) Type of Grant Grant Type and Number Capital Fund Program Grant No: OR16P006 501 15 Replacement Housing Factor Grant No: Date of CFFP: FFY of Grant:2015 FFY of Grant Approval: 2015 Original Annual Statement Reserve for Disasters/Emergencies Revised Annual Statement (revision no: 3) Expires 06/30/2017 Performance and Evaluation Report for Period Ending: Final Performance and Evaluation Report Line Summary by Development Account Total Total Actual Cost 1 Original Revised 2 Obligated Expended 18a 1501 Collateralization or Debt Service paid by the PHA 0 0 0 0 18ba 9000 Collateralization or Debt Service paid Via System of Direct 0 0 0 0 Payment 19 1502 Contingency (may not exceed 8% of line 20) 27,666.00 27,666.00 0 0 20 Amount of Annual Grant:: (sum of lines 2-19) 951,318.00 951,318.00 0 0 21 Amount of line 20 Related to LBP Activities 0 0 0 0 22 Amount of line 20 Related to Section 504 Activities 0 0 0 0 23 Amount of line 20 Related to Security - Soft Costs 0 0 0 0 24 Amount of line 20 Related to Security - Hard Costs 0 0 0 0 25 Amount of line 20 Related to Energy Conservation Measures 107,000.00 0 0 0 Signature of Executive Director Date Signature of Public Housing Director Date 1 To be completed for the Performance and Evaluation Report. 2 To be completed for the Performance and Evaluation Report or a Revised Annual Statement. Annual Statement/Performance and Evaluation Report U.S. Department of Housing and Urban Development Capital Fund Program, Capital Fund Program Replacement Housing Factor and Capital Fund Financing Program OMB No. 2577-0226 Expires 06/30/2017 Page2 form HUD-50075.1 (07/2014)

Part II: Supporting Pages PHA Name: Housing and Community Services Agency of Lane County (HACSA) Grant Type and Number Capital Fund Program Grant No: OR16P006 501 15 CFFP (Yes/ No): Replacement Housing Factor Grant No: Federal FFY of Grant: 2015 Development Number Name/PHA-Wide Activities AMP 200 McKenzie Village AMP 200 McKenzie Village AMP 200 McKenzie Village AMP 200 McKenzie Village AMP 400 Parkview Terrace AMP 400 Parkview Terrace AMP 500 Lindeborg Place AMP 500 Lindeborg Place AMP 500 Lindeborg Place AMP 500 Lindeborg Place General Description of Major Work Categories Development Account No. Quantity Total Total Actual Cost Status of Work Original Revised 1 Funds Obligated 2 Funds Expended 2 Roof Work- Phase 3 1460 1 62,000.00 5,000.00 0 0 To begin upon completion of phase 2 Fencing- Phase 2 1450 300 lf 66,000.00 6,000.00 0 0 To begin upon completion of phase 1 Water Heater Replacement 1465 27 26,210.50 0 0 0 Moved to FY19 Ext. Door and Lock Replacement 1460 27 71,150.00 66,500.00 0 0 Preparing to go out to bid AMP 200 TOTAL 225,710.50 77,500.00 0 0 Screen Door Replacement 1460 150 71,000.00 0 0 0 Cancelled Roof Replacement 1460 1 0 395,278.00 0 0 Work to begin after approval of Significant Amendment AMP 400 TOTAL 71,000.00 395,278.00 0 0 Heating 1465 40 43,000.00 43,000.00 0 0 Summer 2015 Balcony Deck Seal 1460 1 37,867.50 0 0 0 Moved to FY14 Bath Upgrades 1460 2 49,000.00 49,000.00 0 0 Fall 2015 Apartment Lighting 1460 40 28,200.00 0 0 0 Moved to FY14 AMP 500 TOTAL 158,067.50 92,000.00 0 0 Page3 form HUD-50075.1 (07/2014)

AMP 600 Cresview Villa AMP 600 Riverview Terrace Windows/ Patio Doors/ Abatement 1460 34 110,000.00 0 0 0 Phase 1 moved to FY14 Elevator Work 1460 60 0 16,000.00 0 0 Work to begin after approval of Significant Amendment AMP 600 TOTAL 110,000.00 16,000.00 0 0 WORK ITEMS TOTAL 564,778.00 580,778.00 0 0 1 To be completed for the Performance and Evaluation Report or a Revised Annual Statement. 2 To be completed for the Performance and Evaluation Report. Page4 form HUD-50075.1 (07/2014)

Part II: Supporting Pages PHA Name: Housing and Community Services Agency of Lane County (HACSA) Grant Type and Number Capital Fund Program Grant No: OR16P006 501 15 CFFP (Yes/ No): Replacement Housing Factor Grant No: Federal FFY of Grant: 2015 Development Number Name/PHA-Wide Activities General Description of Major Work Categories Development Account No. Quantity Total Total Actual Cost Status of Work Original Revised 1 Funds Obligated 2 Other Architect 1430 45,000.00 29,000.00 0 0 Audit 1411 2,000.00 2,000.00 0 0 Sundries for support work 1430 10,000.00 10,000.00 0 0 GPNA 1430 8,750.00 8,750.00 0 0 Relocation 1495 5,000.00 5,000.00 0 0 Contingency 1502 27,666.00 27,666.00 0 0 Management Improvements 1408 15,000.00 15,000.00 0 0 PHA Wide Non-Dwelling Structures & Equipment- Computer & related hardware Funds Expended 2 1475 10,000.00 10,000.00 0 0 Grant Administration 1410 95,124.00 95,124.00 0 0 Transfer 1406 168,000.00 168,000.00 0 0 Other Total 386,540.00 370,540.00 0 0 TOTAL CAPAITAL GRANT 951,318.00 951,318.00 0 0 Page5 form HUD-50075.1 (07/2014)

Part I: Summary PHA Name/Number: Housing And Community Services Agency of Lane County (HACSA) OR006 Locality (City/County & State) Eugene/Springfield, Lane County, Oregon Original 5-Year Plan Revision No: 1 A. Development Number and Name Work Statement for Year 1 FFY 15 Work Statement for Year 2 FFY 16 Work Statement for Year 3 FFY 17 Work Statement for Year 4 FFY 18 Work Statement for Year 5 FFY 19 B. Physical Improvements Annual Statement 541,431.00 541,431.00 541,431.00 541,431.00 Subtotal C. Management Improvements 15,000.00 15,000.00 15,000.00 15,000.00 D. PHA-Wide Non-dwelling 10,000.00 10,000.00 10,000.00 10,000.00 Structures and Equipment E. Administration 89,400.00 89,400.00 89,400.00 89,400.00 F. Other 70,400.00 70,400.00 70,400.00 70,400.00 G. Operations 168,000.00 168,000.00 168,000.00 168,000.00 H. Demolition 0.00 0.00 0.00 0.00 I. Development 0.00 0.00 0.00 0.00 J. Capital Fund Financing 0.00 0.00 0.00 0.00 Debt Service K. Total CFP Funds 0.00 0.00 0.00 0.00 L. Total Non-CFP Funds 0.00 0.00 0.00 0.00 M. Grand Total 894,675.00 894,675.00 894,675.00 894,675.00 Page 1 of 8 form HUD-50075.2 (4/2008)

Part I: Summary (Continuation) PHA Name/Number: Housing And Community Services Agency of Lane County (HACSA) OR006 Development Number and Work A. Name: Statement for Year 1 FFY 2015 Locality (City/County & State) Eugene/Springfield, Lane County, Oregon Work Statement for Year 2 FFY 2016 Work Statement for Year 3 FFY 2017 Original 5-Year Plan Revision No: 1 Work Statement for Year 4 FFY 2018 AMP 100 Laurelwood Homes Annual 10,000.00 0 17,500.00 5,000.00 Village Statement 72,677.00 188,681.00 183,957.00 80,000.00 AMP 200 Pengra Court 0 8,000.00 180,000.00 95,008.00 AMP 200 Scattered Sites 20,000.00 0 0 0 AMP 300 Scattered Sites 32,000.00 0 0 0 AMP 300 Maplewood 0 0 50,224.00 282,673.00 Meadows AMP 400 Parkview Terrace 51,117.50 175,882.50 0 158,775.00 AMP 500 Lindeborg Place 0 25,000.00 0 40,000.00 AMP 500 Veneta Villa 0 0 0 3,750.00 AMP 500 Veneta Scattered 0 45,867.50 0 0 Sites AMP 600 Cresview Villa 8,000.00 0 5,250.00 0 AMP 600 Riverview Terrace 347,636.50 98,000.00 104,500.00 75,000.00 TOTAL 541,431.00 541,431.00 541,431.00 541,431.00 Work Statement for Year 5 FFY 2019 Page 2 of 8 form HUD-50075.2 (4/2008)

Part II: Supporting Pages Physical Needs Work Statement(s) Work Statement for Year 1 FFY 2015 See Annual Statement Development Number/Name General Description of Major Work Categories AMP 100 Laurelwood Homes: Fencing Village: Roofs Village: Fencing Village: Plumbing & Storm Drains Village: Asbestos Flooring Abatement/Replacement AMP 200 Scattered Sites: Interior/Exterior Mods AMP 300 Scattered Sites: Interior/Exterior Mods AMP 300 Scattered Sites: Fence Replacements AMP 400 Parkview Terrace: Roof Replacement- Phase 2 AMP 500 Lindeborg Place: Electrical Upgrades AMP 600 Riverview Terrace: Building Exterior Elastomeric Coating Work Statement for Year 2 FFY 2016 Quantity Development Number/Name General Description of Major Work Categories 300-800 lf 10,000.00 AMP 600 Riverview Terrace: Roof Replacement 7-12 units 40,677.00 50-200 lf 2,000.00 5-10 20,000.00 2-5 units 10,000.00 10-20 units 20,000.00 10-30 units 30,000.00 50-200 lf 2,000.00 Complex 51,117.50 20-40 units 8,000.00 Complex 159,636.50 Work Statement for Year 2 FFY 2016 Quantity Complex 188,000.00 Subtotal of $541,431.00 Page 3 of 8 form HUD-50075.2 (4/2008)

Part II: Supporting Pages Physical Needs Work Statement(s) Work Statement for Year 1 FFY 2015 See Annual Statement Development Number/Name General Description of Major Work Categories Village: Sidewalks, Asphalt, & Driveways Village: Roofs Water Heater Replacement Village: Kitchen upgrades Village: Plumbing & Storm Drains Village: Water System Village: Asbestos Floor Abatement/Replacement AMP 200 Pengra Court: Sidewalks AMP 400 Parkview Terrace: Heating AMP 500 Lindeborg Place: Heating AMP 500 Veneta Villa Scattered Sites: Driveways/Parking Lots Work Statement for Year 3 FFY 17 Quantity Development Number/Name General Description of Major Work Categories 2-5 sites 10,000.00 AMP 600 Riverview Terrace: Heating 6-11 Roofs 38,223.00 10-20 Units 20,377.00 5-10 Units 40,081.00 7-13 Units 30,000.00 Complex 40,000.00 2-5 Units 10,000.00 600-1200 lf 8,000.00 Complex 175,882.50 Complex 25,000.00 4-8 Sites 45,867.50 Work Statement for Year: 3 FFY 17 Quantity Complex 98,000.00 Subtotal of $541,431.00 Page 4 of 8 form HUD-50075.2 (4/2008)

Part II: Supporting Pages Physical Needs Work Statement(s) Work Statement for Year 1 FFY 2015 See Annual Statement Development Number/Name General Description of Major Work Categories AMP 100 Laurelwood Homes: Site Lighting AMP 100 Laurelwood: Fencing Village: Sidewalks, asphalt parking areas & driveways Village: Roofs Village: Water Heater Replacement Village: Kitchen upgrades Village: Plumbing & Storm Drains Village: Asbestos Floor Abatement/Replacement AMP 200 Pengra Court: Weatherization- Windows, Ext Doors, Heating, Fans AMP 200 Pengra Court: Siding Work Statement for Year 4 FFY 18 Quantity Development Number/Name General Description of Major Work Categories Complex 14,000.00 AMP 300 Maplewood Meadows: ADA Remodel 100-200 lf 3,500.00 AMP 600 Cresview Villa: Electrical Upgrades 150-300 LF 20,000.00 AMP 600 Riverview Terrace: Mailboxes 10-18 Roofs 70,367.50 AMP 600 Riverview Terrace: Concrete Walks & Slab 10-20 units 20,232.50 AMP 600 Riverview Terrace: Heating 6-11 Units 43,357.00 5-11 Units 20,000.00 2-5 Units 10,000.00 Complex 120,000.00 Complex 60,000.00 Work Statement for Year: 4 FFY 18 Quantity 2 Units 50,224.00 Complex 5,250.00 Complex 3,500.00 400-800 LF 5,000.00 Complex 96,000.00 Subtotal of $541,431.00 Page 5 of 8 form HUD-50075.2 (4/2008)

Part II: Supporting Pages Physical Needs Work Statement(s) Work Statement for Year 1 FFY 2015 See Annual Statement Development Number/Name General Description of Major Work Categories AMP 100 Laurelwood Homes: Appliances & Baseboard Heaters Village: Duplex Roofs Village: Kitchen Upgrades Village: Plumbing & Storm Drains Village: Asbestos Floor Abatement/Replacement AMP 200 Pengra Court: Roof AMP 300 Maplewood Meadows: Windows AMP 300 Maplewood Meadows: Siding AMP 300 Maplewood Meadows: Ext Paint AMP 300 Maplewood Meadows: ADA Site Work Work Statement for Year 5 FFY 19 Quantity Development Number/Name General Description of Major Work Categories Complex 5,000.00 AMP 500 Veneta Villa: Parking Lot 5-8 Roofs 30,000.00 AMP 600 Riverview Terrace: Seismic Upgrade 2-5 Units 20,000.00 5-11 Units 20,000.00 2-5 Units 10,000.00 Complex 95,008.00 Complex 68,000.00 Complex 124,673.00 Complex 60,000.00 Site 30,000.00 Work Statement for Year: 5 FFY 19 Quantity 2 Lots 3,750.00 Complex 75,000.00 Subtotal of $541,431.00 Page 6 of 8 form HUD-50075.2 (4/2008)

Part III: Supporting Pages Management Needs Work Statement(s) Work Work Statement for Year 2 Work Statement for Year 3 Statement for FFY 16 FFY 17 Year 1 Development Number/Name Development Number/Name FFY 15 General Description of Major Work Categories General Description of Major Work Categories See Modernization Staff Training 15,000.00 Modernization Staff Training 15,000.00 Annual Equipment (i.e. workstation upgrades, 10,000.00 Equipment (i.e. computers & printers, 10,000.00 communications upgrades, file server) communication upgrades) Statement Management Improvements (CNA s, Energy Audits, GPNA) 3,844.00 Management Improvements (CNA s, Energy Audits, GPNA) 3,844.00 Subtotal of $28,844.00 Subtotal of $28,844.00 Page 7 of 8 form HUD-50075.2 (4/2008)

Part III: Supporting Pages Management Needs Work Statement(s) Work Work Statement for Year 4 Work Statement for Year:5 Statement for FFY 18 FFY 19 Year 1 Development Number/Name Development Number/Name FFY 14 General Description of Major Work Categories General Description of Major Work Categories See Modernization Staff Training 15,000.00 Modernization Staff Training 15,000.00 Annual Equipment (i.e. workstation upgrades, 10,000.00 Equipment (i.e. workstation upgrades, 10,000.00 communications upgrades) communications upgrades, file server) Statement Management Improvements (CNA s, Energy Audits, GPNA) 3,844.00 Management Improvements (CNA s, Energy Audits, GPNA) 3,844.00 Subtotal of $28,844.00 Subtotal of $28,844.00 Page 8 of 8 form HUD-50075.2 (4/2008)