Applicant Contact Information
Applicant Acknowledgment and Agency Information
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.
Local Agency Information
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.
Additional Local Agency Information (if applicable)
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.
Development Impact Fees & Improvements to be Financed by SCIP:
Payment of Taxes/Assessments
Experience of Landowner and Development Group
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?
Upon submission of your application, please send a nonrefundable $1,500 application fee made payable to CSCDA to the attention of:
Vo NguyenStatewide Community Infrastructure Programc/o BLX Group LLC777 South Figueroa Street, Suite 3200Los 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.