SCIP Application and Landowner Information

SCIP Application and Landowner Information Form
Project Information
Name of Applicant:
Project Name:
Project Proceeds Requested:
$ USD
Provide Brief General Description of Overall Project
Project Location or Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
County:
Is the project located in an unincorporated part of the County?

Yes No
Has the City or County in which the project is located been contacted? If so, please provide appropriate contact information below.

Yes No
Name of City/County Agency:
City/County Contact:

First Name Last Name
Phone Number:

Area Code Phone Number
E-mail:
Applicant Contact Information
Primary Contact
Full Name:

First Name Last Name
Title:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number:

Area Code Phone Number
E-mail:
Secondary Contact
Full Name:

First Name Last Name
Title:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number:

Area Code Phone Number
E-mail:

Applicant Acknowledgment and Agency Information
Applicant Acknowledgment

One of the following is true and correct: (A) The undersigned represents the owner(s) of the project, including as joint owners by tenancy in common, community property, joint tenancy or otherwise, or (b) the undersigned has this project under option. The undersigned Applicant acknowledges and agrees that it shall comply with all applicable provisions of the California Labor Code including, as applicable, the payment of prevailing wage. As respect to any and all claims related to prevailing wage, the undersigned assumes all responsibility for the payment of prevailing wage and the compliance with prevailing wage, if required, and specifically waives any and all rights against the California Statewide Communities Development Authority and each participating local agency with respect to the project, as well as their agents, employees, agencies, and consultants (the "Indemnified Parties") pursuant to Labor Code Section 1726(c) and any analogous federal law, and agrees to defend and fully indemnify the Indemnified Parties for damages, claims, fines, penalties, litigations expenses, costs, attorney's fees and interest relating to the project.
Applicant:

First Name Last Name
Title:
Signed ___________________________________________

Dated: ___________________________________________
Local Agency Information
Local Agency Name:
Mailing Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Contact:

First Name Last Name
Title:
Phone Number

Area Code Phone Number
E-mail
Local Agency Acknowledgment

I hereby certify that I am an authorized representative of the Local Agency and that I have been authorized by the Local Agency to execute the Preliminary Application for CSCDA financing.

Signed _______________________________________________

Dated _______________________________________________
Additional Local Agency Information (if applicable)
Local Agency Name:
Mailing Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Contact:

First Name Last Name
Title:
Phone Number

Area Code Phone Number
E-mail
example@example.com
Title:
Phone Number

Area Code Phone Number
E-mail
example@example.com
Local Agency Acknowledgment

I hereby certify that I am an authorized representative of the Local Agency and that I have been authorized by the Local Agency to execute the Preliminary Application for CSCDA financing.

Signed _______________________________________________

Dated _______________________________________________

SCIP Landowner Information Form
THE CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY ("CSCDA") INTENDS TO ISSUE TAX-EXEMPT BONDS (THE "BONDS") TO FINANCE CERTAIN IMPACT FEES FOR THE CITY/COUNTY. UNDER FEDERAL AND STATE SECURITIES LAWS, CSCDA IS REQUIRED TO DISCLOSE ALL MATERIAL FACTS TO THE PURCHASERS OF THE BONDS. FOR THIS REASON, IT IS IMPORTANT THAT YOU ANSWER EACH OF THE FOLLOWING QUESTIONS COMPLETELY AND ACCCURATELY. YOUR PROMPT AND COMPLETE RESPONSE TO THIS QUESTIONNAIRE IS CRITICAL TO CSCDA'S ABILITY TO ISSUE BONDS TO FINANCE YOUR DEVELOPMENT IMPACT FEES.
Name of Current Landowner (or Landowners):
Ownership Structure:
Name of Developer (if different from Landowner):
Is the Applicant the Current Owner of all of the Property within the proposed assessment district?
If No, does the Applicant currently have an option to purchase all of the property within the proposed assessment district?
Is ownership expected to change prior to, or in connection with formation of the assessment district?
If yes, when is this anticipated?
Please Upload a Preliminary Title Report or Other Evidence of Ownership For Each Current Landowner

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Property Information
Gross Acres Owned:
Number of acres proposed for development:
Number of acres developed to date, if any:
List the Assessor's Parcel Numbers for the property:
How long has the current landowner owned the property?
When do you expect the first sale of property?
Development Impact Fees & Improvements to be Financed by SCIP:
Development Impact Fees
Total Amount Impact Fees:
$
Improvements:
Total Amount Improvements:
$

Payment of Taxes/Assessments
What is the current status of property, special taxes and assessments on the property (paid/owing/delinquent).
Have any property taxes or assessments on the property been delinquent at any time during the past 3 years?

Yes No
If YES, please explain.
If YES, please upload a copy of the most recent tax bill
Describe the source of funds that you will use to pay any taxes/assessments to be levied on the property in connection with the Assessment District (i.e., bank savings, land sale proceeds, loan proceeds, etc.).
Do you foresee any difficulty in your ability to make timely payment of your taxes/assessments?

Yes No
If YES, please explain.
Experience of Landowner and Development Group
Describe the development experience of the Landowner developer or affiliated construction entity. Briefly describe any current or recently completed developments undertaken by the Landowner.
Notice Regarding Disclosure

In 1994, the Securities and Exchange Commission adopted amendments (the "Amendments") to Rule 15c2-12 under the Securities Exchange Act of 1934 relating to certain required disclosure information that must be made available to prospective purchasers of municipal bonds. Under the Amendments and other federal and state securities laws, certain material information must be disclosed (i) in connection with the initial offering of Bonds with respect to material persons; and (ii) on an ongoing basis with respect to obligated persons.

Whether a property owner/developer might be a material person or an obligated person will depend on all of the facts and circumstances. If the information you provide in response to this questionnaire indicates this might be the case, the financing team will review with you the information that may need to be disclosed to potential Bond investors in order to satisfy the Amendments and other federal and state securities laws.

If information on the proposed development of your property is disclosed in connection with the sale of the Bonds, you will be required to certify at that time that the information is true and correct and does not omit to state any material fact.
If we have any additional questions regarding the property, who is the appropriate person to contact?
Firm Name:
Primary Contact:

First Name Last Name
Title:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number:

Area Code Phone Number
E-mail:
Upon submission of your application, please send a nonrefundable $1,500 application fee made payable to CSCDA to the attention of:

Vo Nguyen
Statewide Community Infrastructure Program
c/o BLX Group LLC
777 South Figueroa Street, Suite 3200
Los Angeles, CA 90017

After submission of your application you will receive a PDF copy. Please forward a signed and dated copy including the local agency acknowledgment.
Should be Empty:

SCIP Application and Landowner Information Form