Project Based Voucher Contract Renewal with The Rose of DubuqueCity of Dubuque
City Council
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Copyrighted
October 6, 2025
ITEM TITLE: Project Based Voucher Contract Renewal with The Rose of
Dubuque
SUMMARY: City Manager recommending City Council approve the
renewal of a contract with The Rose of Dubuque for a five-
year term and request that the City Manager be approved to
execute the renewal contract.
RESOLUTION Approving A Renewal Contract Agreement
Between The City Of Dubuque And The Rose Of Dubuque
L.P. For The Project Based Voucher Program
SUGGUESTED Receive and File; Adopt Resolution(s)
DISPOSITION:
ATTACHMENTS:
1. MVM Memo
2. Staff Memo for Renewal 2025
3. PBV Contract Renewal Resolution
4. 2025_Renewal Contract_5253013_Part1
5. 2025_Renewal Contract_5253013_Part2
6. 2025_HAP Contract_Exhibits
7. Tenancy Addendum_52530CENG_3
8. Statement of Family Responsibility_52578b_4
Page 198 of 1264
THE CITY OF
Dubuque
DUB TEE
All -America City
Masterpiece on the Mississippi
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TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Project Based Voucher Contract Renewal with The Rose of Dubuque
DATE: October 1, 2025
Interim Housing & Community Development Director Sandi Fowler is recommending
City Council approve the renewal of a contract with The Rose of Dubuque for a five-year
term and request that the Housing & Community Development Director and the City
Manager be approved to execute the renewal contract.
The Housing & Community Development Department has successfully managed a
Project Based Voucher Program with The Rose of Dubuque since 2012. The initial
contract term was for 10 years and was extended in 2022 for an additional one-year
term and renewed again in 2023 for a two-year term. The current Project Based
Voucher contract will expire on 10/12/2025. The City of Dubuque Housing &
Community Development Department and The Rose of Dubuque wish to renew the
Project Based Voucher (PBV) contract.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
v
Micliael C. Van Milligen
MCVM:sv
Attachment
CC' Crenna Brumwell, City Attorney
Cori Burbach, Assistant City Manager
Sandi Fowler, Interim Housing & Community Development Director
Page 199 of 1264
THE C
DUUB--&'--TE
Masterpiece on the Mississippi
TO: Michael C Van Milligen, City Manager
FROM: Sandi Fowler, Housing & Community Development Director
DATE: September 29, 2025
Dubuque
All -America City
-1 NiaLf n'N_ I I 1.1
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(I
2007+2012.2013
2017*2019
RE: Project Based Voucher Contract Renewal with The Rose of Dubuque
INTRODUCTION
The Housing & Community Development Department has successfully managed a
Project Based Voucher Program with The Rose of Dubuque since 2012. The initial
contract term was for 10 years and was extended in 2022 for an additional one-year
term and renewed again in 2023 for a two-year term. The current Project Based
Voucher contract will expire on 10/12/2025. The City of Dubuque Housing &
Community Development Department and The Rose of Dubuque wish to renew the
Project Based Voucher (PBV) contract for a five-year term on 10/12/2025 and ask that
the Housing & Community Development Director be approved to execute the renewal
contract.
BACKGROUND
Project -based vouchers (PBVs) are a component of a public housing agency's (PHA's)
Housing Choice Voucher (HCV) program. PHAs are not allocated additional funding for
PBV units; the PHA uses its tenant -based voucher funding to allocate project -based
units to a specific project. Applicants are selected for PBVs through a waiting list
process managed by the City of Dubuque PHA.
The current PBV contract with The Rose of Dubuque is for 17 dedicated, one bedroom,
units. The City's PHA and The Rose work collaboratively to pull applicants from the
PBV waiting list to achieve a successful lease up in a Project Based Unit. This voucher
differs from a regular Housing Choice Voucher (HCV) due to the nature of the voucher.
The PBV voucher is tied to a specific unit at The Rose of Dubuque; when a tenant
moves into that unit, they are covered by the voucher, but if they would choose to move
out of that designated unit, they would no longer be covered under the PBV Program
voucher since that voucher stays with that specific unit. This contrasts with an HCV
voucher. The HCV voucher is tied to the tenant and follows them, so if they were
issued an HCV voucher, that voucher would stay with them wherever they would decide
to move. All 17 units under this contract with The Rose of Dubuque are Project Based
Vouchers (unit based).
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The Rose of Dubuque has housed many elderly people in our community over the years
with these Project Based Vouchers and we would like to continue the partnership with a
renewed contract agreement.
RECOMMENDATION
I respectfully request approval for the Housing & Community Development Director to
execute a five-year contract renewal agreement with The Rose of Dubuque for the
Project Based Voucher Program. Additionally, requesting that the Director of Housing
and Community Development and the City Manager are authorized to approve the
contract.
ION
Page 201 of 1264
Prepared by Gina Hodgson Assisted Housing Spvsr, 350 W 6'h Street #312 Dubuque IA 52001 (563) 690-6096
Return to Adrienne N. Breitfelder, City Clerk, 50 W. 1311 St., Dubuque, IA 52001, (563) 589-4100
RESOLUTION NO. 314-25
RESOLUTION APPROVING A RENEWAL CONTRACT AGREEMENT BETWEEN THE
CITY OF DUBUQUE AND THE ROSE OF DUBUQUE L.P. FOR THE PROJECT BASED
VOUCHER PROGRAM
Whereas, the U.S. Department of Housing and Urban Development supports a
Project Based Voucher Program as a component of the Housing Choice Voucher
Program requires a contract to be in place tied to specific project based units; and
Whereas, the City of Dubuque originally entered into a contract with The Rose of
Dubuque L.P. in October 2012 for a ten-year term; and
Whereas, the City of Dubuque's extended the contract with The Rose of
Dubuque L.P. for 17 PBV units for a one-year term in 2022; and
Whereas, the City of Dubuque's extended the contract with The Rose of
Dubuque L.P. for 17 PBV units for a two-year term in 2023 that is due to expire
10/12/2025; and
Whereas, the City of Dubuque Housing & Community Development Department
and The Rose of Dubuque wish to renew the contract for the Project Based Vouchers
for a five-year term to continue to administer the Project Based Voucher program at The
Rose of Dubuque.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF DUBUQUE, IOWA THAT:
Section 1: That said Renewal Contract Agreement between the City of Dubuque
and The Rose of Dubuque L.P. for the Project Based Voucher program is hereby
approved.
Section 2: That the City Manager is authorized and directed to execute said
Renewal Contract Agreement .
Passed, approved, and adopted this 6th day of October 2025.
B . avanagh, Mayor
Attest:
Trish L. Gleason, Assistant City Clerk
OMB Approval No. 2577-0169
(exp. 04/30/2026)
U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
SECTION 8 PROJECT -BASED VOUCHER PROGRAM
HOUSING ASSISTANCE PAYMENTS CONTRACT
EXISTING HOUSING
PART 1 OF HAP CONTRACT
OMB Burden Statement. The public reporting burden for this collection of information is estimated to average 1
hour. This form is required to establish terms between a PHA and owner to provide housing assistance. This contract
allows a PHA to enter into a HAP contract with the owner to provide housing assistance payments for eligible families.
Assurances of confidentiality are not provided under this collection. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions to reduce this burden, to the Office of Public
and Indian Housing, US. Department of Housing and Urban Development, Washington, DC 20410. HUD may not
conduct and sponsor, and a person is not required to respond to, a collection of information unless the collection
displays a valid control number.
Privacy Notice. The Department of Housing and Urban Development (HUD) is authorized to collect the information
on this form by 24 CFR § 983.202. This contract allows a PHA to enter into a HAP contract with the owner to provide
housing assistance payments for eligible families. Assurances of confidentiality are not provided under this collection.
The Personally Identifiable Information (PII) data collected on this form are not stored or retrieved within a system of
record.
1. CONTRACT INFORMATION
a. Parties
This housing assistance payments (HAP) contract is entered into between:
City of Dubuque_IA087
The Rose of Dubuque, L.P.
b. Contents of contract
( PHA) and
(owner).
The HAP contract consists of Part 1, Part 2, and the contract exhibits listed in
paragraph c.
C. Contract exhibits
The HAP contract includes the following exhibits:
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EXHIBIT A: TOTAL NUMBER OF UNITS IN PROJECT COVERED BY
THIS HAP CONTRACT; INITIAL RENT TO OWNER; AND
DESCRIPTION OF THE CONTRACT UNITS. (See 24 CFR
983.203 for required items.)
EXHIBIT B: SERVICES, MAINTENANCE AND EQUIPMENT TO BE
PROVIDED BY THE OWNER WITHOUT CHARGES IN
ADDITION TO RENT TO OWNER
EXHIBIT C: UTILITIES AVAILABLE IN THE CONTRACT UNITS,
INCLUDING A LISTING OF UTILITY SERVICES TO BE
PAID BY THE OWNER (WITHOUT CHARGES IN ADDITION
TO RENT TO OWNER) AND UTILITIES TO BE PAID BY THE
TENANTS
EXHIBIT D: FEATURES PROVIDED TO COMPLY WITH PROGRAM
ACCESSIBILITY FEATURES OF SECTION 504 OF THE
REHABILITATION ACT OF 1973 AND IMPLEMENTING
REGULATIONS AT 24 CFR PART 8
ADDITIONAL EXHIBITS
d. Effective date and term of the HAP contract
1. Effective date
a. The PHA may not enter into a HAP contract for any contract unit
until the PHA (or an independent entity, as applicable) has
determined that the unit meets the PBV inspection requirements.
b. For all contract units, the effective date of the HAP contract is:
10/12/2025
The term of the HAP contract begins on the effective date.
2. Length of initial term
a. Subject to paragraph 2.b, the initial term of the HAP contract for
all contract units is:
60 Months (5 Years
b. The initial term of the HAP contract may not be less than one year,
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nor more than twenty years.
3. Extension of term
The PHA and owner may agree to enter into an extension of the HAP
contract at the time of initial HAP contract execution, or any time prior to
expiration of the contract. Any extension, including the term of such
extension, must be in accordance with HUD requirements. A PHA must
determine that any extension is appropriate to achieve long-term
affordability of the housing or expand housing opportunities.
4. Requirement for sufficient appropriated funding
a. The length of the initial term and any extension term shall be
subject to availability, as determined by HUD, or by the PHA in
accordance with HUD requirements, of sufficient appropriated
funding (budget authority), as provided in appropriations acts and
in the PHA's annual contributions contract (ACC) with HUD, to
make full payment of housing assistance payments due to the
owner for any contract year in accordance with the HAP contract.
b. The availability of sufficient funding must be determined by HUD
or by the PHA in accordance with HUD requirements. If it is
determined that there may not be sufficient funding to continue
housing assistance payments for all contract units and for the full
term of the HAP contract, the PHA has the right to terminate the
HAP contract by notice to the owner for all or any of the contract
units. Such action by the PHA shall be implemented in accordance
with HUD requirements.
e. Occupancy and payment
1. Payment for occupied unit
During the term of the HAP contract, the PHA shall make housing
assistance payments to the owner for the months during which a contract
unit is leased to and occupied by an eligible family. If an assisted family
moves out of a contract unit, the owner may keep the housing assistance
payment for the calendar month when the family moves out ("move -out
month"). However, the owner may not keep the payment if the PHA
determines that the vacancy is the owner's fault.
2. Vacancy payment
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THE PHA HAS DISCRETION WHETHER TO INCLUDE THE
VACANCY PAYMENT PROVISION (PARAGRAPH e.2), OR TO
STRIKE THIS PROVISION FROM THE HAP CONTRACT FORM.
a. If an assisted family moves out of a contract unit, the PHA may
provide vacancy payments to the owner for a PHA -determined
vacancy period extending from the beginning of the first calendar
month after the move -out month for a period not exceeding two
full months following the move -out month.
b. The vacancy payment to the owner for each month of the
maximum two -month period will be determined by the PHA, and
cannot exceed the monthly rent to owner under the assisted lease,
minus any portion of the rental payment received by the owner
(including amounts available from the tenant's security deposit).
Any vacancy payment may cover only the period the unit remains
vacant.
C. The PHA may make vacancy payments to the owner only if:
The owner gives the PHA prompt, written notice certifying
that the family has vacated the unit and the date when the
family moved out (to the best of the owner's knowledge
and belief);
2. The owner certifies that the vacancy is not the fault of the
owner and that the unit was vacant during the period for
which payment is claimed;
3. The owner certifies that it has taken every reasonable
action to minimize the likelihood and length of vacancy;
and
4. The owner provides any additional information required
and requested by the PHA to verify that the owner is
entitled to the vacancy payment.
d. The PHA must take every reasonable action to minimize the
likelihood and length of vacancy.
e. The owner may refer families to the PHA for placement on the
PBV waiting list.
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f. The owner must submit a request for vacancy payments in the
form and manner required by the PHA and must provide any
information or substantiation required by the PHA to determine the
amount of any vacancy payments.
3. PHA is not responsible for family damage or debt to owner
Except as provided in this paragraph e (Occupancy and Payment), the
PHA will not make any other payment to the owner under the HAP
contract. The PHA will not make any payment to the owner for any
damages to the unit, or for any other amounts owed by a family under the
family's lease.
f. Income -mixing requirement
1. Except as provided in paragraphs f.2 through f.5 below, the PHA will not
make housing assistance payments under the HAP contract for more than
the greater of 25 units or 25 percent of the total number of dwelling units
(assisted or unassisted) in any project. The term "project" means a single
building, multiple contiguous buildings, or multiple buildings on
contiguous parcels of land assisted under this HAP contract.
2. The limitation in paragraph f.1 does not apply to single-family buildings.
In referring eligible families to the owner for admission to the number of
contract units in any project exceeding the 25 unit or 25 percent limitation
under paragraph f.1, the PHA shall give preference to the applicable
families as listed in f.8 below, for the number of contract units exclusively
made available for occupancy by such families. The owner shall rent that
number of contract units to such families referred by the PHA from the
PHA waiting list.
4. Up to the greater of 25 units or 40 percent of units (instead of the greater
of 25 units or 25 percent of units) in a project may be project -based if the
project is located in a census tract with a poverty rate of 20 percent or less.
Units that were previously subject to certain federal rent restrictions or
receiving another type of long-term housing subsidy provided by HUD do
not count toward the income -mixing requirement if, in the five years prior
to issuance of the Request for Proposal or notice of owner selection (for
projects selected based on a prior competition or without competition), the
unit received one of the forms of HUD assistance or was under a federal
rent restriction as described in f.6 and f.7, below.
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The following specifies the number of contract units (if any) that received
one of the following forms of HUD assistance:
Public Housing or Operating Funds;
IIProject -Based Rental Assistance (including Mod Rehab and Mod
Rehab Single -Room Occupancy);
❑ Housing for the Elderly (Section 202 or the Housing Act of 1959);
❑ Housing for Persons with Disabilities (Section 811 of the
Cranston -Gonzalez Affordable Housing Act);
❑ Rent Supplement Program;
❑ Rental Assistance Program;
❑ Flexible Subsidy Program.
Place a check mark in front of the form of assistance received by any of
the contract units. The following total number of contract units received a
form of HUD assistance listed above:
17
If all of the units in the project received such assistance, you may skip
number g.8, below.
The following specifies the number of contract units (if any) that were
under any of the following federal rent restrictions:
❑ Section 236;
❑ Section 221(d)(3) or (d)(4) BMIR (below -market interest rate);
❑ Housing for the Elderly (Section 202 or the Housing Act of 1959);
❑ Housing for Persons with Disabilities (Section 811 of the
Cranston -Gonzalez Affordable Housing Act);
❑ Flexible Subsidy Program.
Place a check mark in front of the type of federal rent restriction that
applied to any of the contract units. The following total number of contract
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units were subject to a federal rent restriction listed above:
I
If all of the units in the project were subject to a federal rent restriction,
you may skip number g.8, below.
The following specifies the number of contract units (if any) exclusively
made available to elderly families, families eligible for supportive
services, or eligible youth receiving Family Unification Program or Foster
Youth to Independence (FUP/FYI) assistance:
a. Place a check mark here II if any contract units are exclusively
made available for occupancy by elderly families; The following
number of contract units shall be rented to elderly families:
17
b. Place a check mark here n if any contract units are exclusively
made available for occupancy by families eligible for supportive
services. The following number of contract units shall be rented to
families eligible for supportive services:
17
Place a check mark here if any contract units are exclusively
made available for occupancy by eligible youth receiving FUP/FYI
assistance. The following number of contract units shall be rented
to eligible families receiving FUP/FYI assistance:
9. The PHA and owner must comply with all HUD requirements regarding
income mixing.
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EXECUTION OF HAP CONTRACT FOR EXISTING HOUSING
I/We, the undersigned, certify under penalty of perjury that the information provided above is true and
correct. WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject to
criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative
penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012; 31 U.S.C. §3729, 3802).
PUBLIC HOUSING AGENCY (PHA)
Name of PHA (Print)
City of Dubuque
By.
Signat re of authorized represen ative
Michael C. Van Milligan, City Manager
Name and official title (Print)
10/7/2025
Date
OWNER
Name of Owner (Print)
The Rose of Dubuque, L.P.
By:
Signature of authorized representative
Gregory A. McClenahan, President of Gen. Ptr.
Name and official title (Print)
Date
Project -Based Voucher Program
HAP Contract for Existing Housing
Previous editions are obsolete
HUD 52530B Page - 8 of Part 1
(04/2023)
OMB Approval No. 2577-0169
(exp. 04/30/2026)
U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
SECTION 8 PROJECT -BASED VOUCHER PROGRAM
HOUSING ASSISTANCE PAYMENTS CONTRACT
EXISTING HOUSING
PART 2 OF HAP CONTRACT
OMB Burden Statement. The public reporting burden for this collection of information is estimated to average 1
hour. This form is required to establish terms between a PHA and owner to provide housing assistance. This contract
allows a PHA to enter into a HAP contract with the owner to provide housing assistance payments for eligible families.
Assurances of confidentiality are not provided under this collection. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions to reduce this burden, to the Office of Public
and Indian Housing, US. Department of Housing and Urban Development, Washington, DC 20410. HUD may not
conduct and sponsor, and a person is not required to respond to, a collection of information unless the collection
displays a valid control number.
2. DEFINITIONS
Contract units. The housing units covered by this HAP contract. The contract
units are described in Exhibit A.
Controlling interest. In the context of PHA -owned units (see definition below),
controlling interest means:
(a) Holding more than 50 percent of the stock of any corporation; or
(b) Having the power to appoint more than 50 percent of the members of the
board of directors of a non -stock corporation (such as a non-profit corporation); or
(c) Where more than 50 percent of the members of the board of directors of any
corporation also serve as directors, officers, or employees of the PHA; or
(d) Holding more than 50 percent of all managing member interests in an LLC; or
(e) Holding more than 50 percent of all general partner interests in a partnership;
or
(f) Having equivalent levels of control in other ownership structures.
Existing housing. Housing units that already exist on the proposal selection date
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and that substantially comply with the housing quality standards on that date. The
units must fully comply with the housing quality standards before execution of the
HAP contract.
Family. The persons approved by the PHA to reside in a contract unit with
assistance under the program.
HAP contract. This housing assistance payments contract between the PHA and
the owner. The contract consists of Part 1, Part 2, and the contract exhibits (listed
in section 1.c of the HAP contract).
Household. The family and any PHA -approved live-in aide.
Housing assistance payment. The monthly assistance payment by the PHA for a
contract unit, which includes: (1) a payment to the owner for rent to the owner
under the family's lease minus the tenant rent; and (2) an additional payment to or
on behalf of the family if the utility allowance exceeds total tenant payment.
Housing quality standards (HQS). The HUD minimum quality standards for
dwelling units occupied by families receiving project -based voucher program
assistance.
HUD. U.S. Department of Housing and Urban Development.
HUD requirements. HUD requirements which apply to the project -based
voucher program. HUD requirements are issued by HUD headquarters, as
regulations, Federal Register notices or other binding program directives.
Owner. Any person or entity who has the legal right to lease or sublease a unit to
a participant.
Premises. The building or complex in which a contract unit is located, including
common areas or grounds.
Principal or interested party. This term includes a management agent and other
persons or entities participating in project management, and the officers and
principal members, shareholders, investors, and other parties having a substantial
interest in the HAP contract, or in any proceeds or benefits arising from the HAP
contract.
Program. The project -based voucher program (see authorization for project -
based assistance at 42 U.S.C. 1437f(o)(13)).
PHA. Public Housing Agency. The agency that has entered into the HAP contract
with the owner. The agency is a public housing agency as defined in the United
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States Housing Act of 1937 (42 U.S.C. 1437a(b)(6)).
PHA -owned units. A unit is "owned by a PHA" if the unit is in a project that is:
(a) Owned by the PHA (which includes a PHA having a "controlling interest" in
the entity that owns the unit; see definition above);
(b) Owned by an entity wholly controlled by the PHA; or
(c) Owned by a limited liability company (LLC) or limited partnership in which
the PHA (or an entity wholly controlled by the PHA) holds a controlling interest
in the managing member or general partner.
Proposal selection date. The date the PHA gives written notice of proposal
selection to the owner whose proposal is selected in accordance with the criteria
established in the PHA's administrative plan.
Rent to owner. The total monthly rent payable to the owner under the lease for a
contract unit. Rent to owner includes payment for any housing services,
maintenance and utilities to be provided by the owner in accordance with the
lease.
Tenant. The person or persons (other than a live-in aide) who executes the lease
as a lessee of the dwelling unit.
Tenant rent. The portion of the rent to owner payable by the family, as
determined by the PHA in accordance with HUD requirements. The PHA is not
responsible for paying any part of the tenant rent.
3. PURPOSE
a. This is a HAP contract between the PHA and the owner.
b. The purpose of the HAP contract is to provide housing assistance
payments for eligible families who lease contract units that comply with
the HUD HQS from the owner.
C. The PHA must make housing assistance payments to the owner in
accordance with the HAP contract for contract units leased and occupied
by eligible families during the HAP contract term. HUD provides funds to
the PHA to make housing assistance payments to owners for eligible
families.
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4. RENT TO OWNER; HOUSING ASSISTANCE PAYMENTS
a. Amount of initial rent to owner
The initial rent to owner for each contract unit is stated in Exhibit A,
which is attached to and made a part of the HAP contract. At the
beginning of the HAP contract term, and until rent to owner is adjusted in
accordance with section 5 of the HAP contract, the rent to owner for each
bedroom size (number of bedrooms) shall be the initial rent to owner
amount listed in Exhibit A.
Place a check mark hereEZI if the PHA has elected not to reduce rents
below the initial rent to owner.
b. HUD rent requirements
Notwithstanding any other provision of the HAP contract, the rent to
owner may in no event exceed the amount authorized in accordance with
HUD requirements. The PHA has the right to reduce the rent to owner, at
any time, to correct any errors in establishing or adjusting the rent to
owner in accordance with HUD requirements. The PHA may recover any
overpayment from the owner.
C. PHA payment to owner
1. Each month the PHA must make a housing assistance payment to
the owner for a unit under lease to and occupied by an eligible
family in accordance with the HAP contract.
2. The monthly housing assistance payment to the owner for a
contract unit is equal to the amount by which the rent to owner
exceeds the tenant rent.
3. Payment of the tenant rent is the responsibility of the family. The
PHA is not responsible for paying any part of the tenant rent, or for
paying any other claim by the owner against a family. The PHA is
responsible only for making housing assistance payments to the
owner on behalf of a family in accordance with the HAP contract.
4. The owner will be paid the housing assistance payment under the
HAP contract on or about the first day of the month for which
payment is due, unless the owner and the PHA agree on a later
date.
5. To receive housing assistance payments in accordance with the
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HAP contract, the owner must comply with all the provisions of
the HAP contract. Unless the owner complies with all the
provisions of the HAP contract, the owner does not have a right to
receive housing assistance payments.
6. If the PHA determines that the owner is not entitled to the payment
or any part of it, the PHA, in addition to other remedies, may
deduct the amount of the overpayment from any amounts due the
owner, including amounts due under any other housing assistance
payments contract.
7. The owner will notify the PHA promptly of any change of
circumstances that would affect the amount of the monthly housing
assistance payment, and will return any payment that does not
conform to the changed circumstances.
d. Termination of assistance for family
The PHA may terminate housing assistance for a family under the HAP
contract in accordance with HUD requirements. The PHA must notify the
owner in writing of its decision to terminate housing assistance for the
family in such case.
5. ADJUSTMENT OF RENT TO OWNER
a. PHA determination of adjusted rent
At each annual anniversary during the term of the HAP contract,
the PHA shall adjust the amount of rent to owner, upon request to
the PHA by the owner, in accordance with law and HUD
requirements. In addition, the PHA shall adjust the rent to owner
when there is a ten percent decrease in the published, applicable
Fair Market Rent in accordance with 24 CFR 983.302. However, if
the PHA has elected within the HAP contract not to reduce rents
below the initial rent to owner, the rent to owner shall not be
reduced below the initial rent to owner except in those cases
described in 24 CFR 983.302(c)(2).
2. The adjustment of rent to owner shall always be determined in
accordance with all HUD requirements. The amount of the rent to
owner may be adjusted up or down, in the amount defined by the
PHA in accordance with HUD requirements.
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b. Reasonable rent
The rent to owner for each contract unit, as adjusted by the PHA in
accordance with 24 CFR 983.303, may at no time exceed the reasonable
rent charged for comparable units in the private unassisted market, except
in cases where the PHA has elected within the HAP contract not to reduce
rents below the initial rent to owner. The reasonable rent shall be
determined by the PHA in accordance with HUD requirements.
C. No special adjustments
The PHA will not make any special adjustments of the rent to owner.
d. Owner compliance with HAP contract
The PHA shall not approve, and the owner shall not receive, any increase
of rent to owner unless all contract units are in accordance with the HQS,
and the owner has complied with the terms of the assisted leases and the
HAP contract.
e. Notice of rent adjustment
Rent to owner shall be adjusted by written notice by the PHA to the owner
in accordance with this section. Such notice constitutes an amendment of
the rents specified in Exhibit A.
6. OWNER RESPONSIBILITY
The owner is responsible for:
a. Performing all management and rental functions for the contract units.
b. Maintaining the units in accordance with HQS.
C. Complying with equal opportunity requirements.
d. Enforcing tenant obligations under the lease.
e. Paying for utilities and housing services (unless paid by the family under
the lease).
f. Collecting from the tenant:
1. Any security deposit;
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2. The tenant rent; and
3. Any charge for unit damage by the family.
7. OWNER CERTIFICATION
The owner certifies that at all times during the term of the HAP contract:
a. All contract units are in good and tenantable condition. The owner is
maintaining the premises and all contract units in accordance with the
HQS.
b. The owner is providing all the services, maintenance and utilities as
agreed to under the HAP contract and the leases with assisted families.
C. Each contract unit for which the owner is receiving housing assistance
payments is leased to an eligible family referred by the PHA, and the lease
is in accordance with the HAP contract and HUD requirements.
d. To the best of the owner's knowledge, the members of the family reside in
each contract unit for which the owner is receiving housing assistance
payments, and the unit is the family's only residence.
e. The owner (including a principal or other interested party) is not the
parent, child, grandparent, grandchild, sister, or brother of any member of
a family residing in a contract unit unless the PHA has determined that
approving leasing of the unit would provide a reasonable accommodation
for a family member who is a person with disabilities.
f. The amount of the housing assistance payment is the correct amount due
under the HAP contract.
g. The rent to owner for each contract unit does not exceed rents charged by
the owner for other comparable unassisted units.
h. Except for the housing assistance payment and the tenant rent as provided
under the HAP contract, the owner has not received and will not receive
any payments or other consideration (from the family, the PHA, HUD, or
any other public or private source) for rental of the contract unit.
i. The family does not own, or have any interest in the contract unit. If the
owner is a cooperative, the family may be a member of the cooperative.
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8. CONDITION OF UNITS
a. Owner maintenance and operation
The owner must maintain and operate the contract units and premises to
provide decent, safe and sanitary housing in accordance with the HQS,
including performance of ordinary and extraordinary maintenance. The
owner must provide all the services, maintenance and utilities set forth in
Exhibits B and C, and in the lease with each assisted family.
b. PHA inspections
The PHA must inspect each contract unit before execution of the
HAP contract. The PHA may not enter into a HAP contract
covering a unit until the unit fully complies with the HQS.
2. Before providing assistance to a new family in a contract unit, the
PHA must inspect the unit. The PHA may not provide assistance
on behalf of the family until the unit fully complies with the HQS.
3. At least biennially during the term of the HAP contract, the PHA
must inspect a random sample, consisting of at least 20 percent of
the contract units in each building, to determine if the contract
units and the premises are maintained in accordance with the HQS.
Turnover inspections pursuant to paragraph 2 of this section are
not counted toward meeting this biennial inspection requirement.
4. If more than 20 percent of the sample of inspected contract units in
a building fail the initial inspection, the PHA must reinspect 100
percent of the contract units in the building.
5. The PHA must inspect contract units whenever needed to
determine that the contract units comply with the HQS and that the
owner is providing maintenance, utilities, and other services in
accordance with the HAP contract. The PHA must take into
account complaints and any other information that comes to its
attention in scheduling inspections.
C. Violation of the housing quality standards
1. If the PHA determines a contract unit is not in accordance with the
HQS, the PHA may exercise any of its remedies under the HAP
contract for all or any contract units. Such remedies include
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termination, suspension or reduction of housing assistance
payments, and termination of the HAP contract.
2. The PHA may exercise any such contractual remedy respecting a
contract unit even if the family continues to occupy the unit.
3. The PHA shall not make any housing assistance for a dwelling unit
that fails to meet the HQS, unless the owner corrects the defect
within the period specified by the PHA and the PHA verifies the
correction. If a defect is life threatening, the owner must correct
the defect within no more than 24 hours. For other defects, the
owner must correct the defect within no more than 30 calendar
days (or any PHA -approved extension).
d. Maintenance and replacement —owner's standard practice
Maintenance and replacement (including redecoration) must be in
accordance with the standard practice for the building concerned as
established by the owner.
9. LEASING CONTRACT UNITS
a. Selection of tenants
During the term of the HAP contract, the owner must lease all
contract units to eligible families selected and referred by the PHA
from the PHA waiting list. (See 24 CFR 983.251.)
2. The owner is responsible for adopting written tenant selection
procedures that are consistent with the purpose of improving
housing opportunities for very low-income families and reasonably
related to program eligibility and an applicant's ability to perform
the lease obligations.
3. Consistent with HUD requirements and Federal civil rights and fair
housing requirements, the owner may apply its own
nondiscriminatory tenant selection procedures in determining
whether to admit a family referred by the PHA for occupancy of a
contract unit. The owner may refer families to the PHA for
placement on the PBV waiting list.
4. The owner must promptly notify in writing any rejected applicant
of the grounds for rejection.
5. The PHA must determine family eligibility in accordance with
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HUD requirements.
6. The contract unit leased to each family must be appropriate for the
size of the family under the PHA's subsidy standards.
7. If a contract unit was occupied by an eligible family at the time the
unit was selected by the PHA, or is so occupied on the effective
date of the HAP contract, the owner must offer the family the
opportunity to lease the same or another appropriately -sized
contract unit with assistance under the HAP contract.
8. The owner is responsible for screening and selecting tenants from
the families referred by the PHA from its waiting list.
b. Vacancies
The owner must promptly notify the PHA of any vacancy in a
contract unit. After receiving the owner notice, the PHA shall
make every reasonable effort to refer a sufficient number of
families for owner to fill the vacancy.
2. The owner must rent vacant contract units to eligible families on
the PHA waiting list referred by the PHA.
3. The PHA and the owner must make reasonable, good faith efforts
to minimize the likelihood and length of any vacancy.
4. If any contract units have been vacant for a period of 120 or more
days since owner notice of vacancy (and notwithstanding the
reasonable, good faith efforts of the PHA to fill such vacancies),
the PHA may give notice to the owner amending the HAP contract
to reduce the number of contract units by subtracting the number
of contract units (by number of bedrooms) that have been vacant
for such period.
10. TENANCY
a. Lease
The lease between the owner and each assisted family must be in
accordance with HUD requirements. In all cases, the lease must include
the HUD -required tenancy addendum. The tenancy addendum must
include, word-for-word, all provisions required by HUD.
b. Termination of tenancy
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The owner may terminate a tenancy only in accordance with the
lease and HUD requirements.
2. The owner must give the PHA a copy of any owner eviction notice
to the tenant at the same time that the owner gives notice to the
tenant. Owner eviction notice means a notice to vacate, or a
complaint or other initial pleading used to commence an eviction
action under State or local law.
C. Family payment
The portion of the monthly rent to owner payable by the family
("tenant rent") will be determined by the PHA in accordance with
HUD requirements. The amount of the tenant rent is subject to
change during the term of the HAP contract. Any changes in the
amount of the tenant rent will be effective on the date stated in a
notice by the PHA to the family and the owner.
2. The amount of the tenant rent as determined by the PHA is the
maximum amount the owner may charge the family for rent of a
contract unit, including all housing services, maintenance and
utilities to be provided by the owner in accordance with the HAP
contract and the lease.
3. The owner may not demand or accept any rent payment from the
tenant in excess of the tenant rent as determined by the PHA. The
owner must immediately return any excess rent payment to the
tenant.
4. The family is not responsible for payment of the portion of the
contract rent covered by the housing assistance payment under the
HAP contract. The owner may not terminate the tenancy of an
assisted family for nonpayment of the PHA housing assistance
payment.
5. The PHA is responsible only for making the housing assistance
payments to the owner on behalf of the family in accordance with
the HAP contract. The PHA is not responsible for paying the
tenant rent, or any other claim by the owner.
d. Other owner charges
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Except as provided in paragraph 2, the owner may not require the
tenant or family members to pay charges for meals or supportive
services. Nonpayment of such charges is not grounds for
termination of tenancy.
2. In assisted living developments receiving project -based voucher
assistance, owners may charge tenants, family members, or both
for meals or supportive services. These charges may not be
included in the rent to owner, nor may the value of meals and
supportive services be included in the calculation of reasonable
rent. Non-payment of such charges is grounds for termination of
the lease by the owner in an assisted living development.
3. The owner may not charge the tenant or family members extra
amounts for items customarily included in rent in the locality or
provided at no additional cost to the unsubsidized tenant in the
premises.
e. Security deposit
The owner may collect a security deposit from the family.
2. The owner must comply with HUD and PHA requirements, which
may change from time to time, regarding security deposits from a
tenant.
3. The PHA may prohibit security deposits in excess of private
market practice, or in excess of amounts charged by the owner to
unassisted families.
4. When the family moves out of the contract unit, the owner, subject
to State and local law, may use the security deposit, including any
interest on the deposit, in accordance with the lease, as
reimbursement for any unpaid tenant rent, damages to the unit or
other amounts which the family owes under the lease. The owner
must give the family a written list of all items charged against the
security deposit and the amount of each item. After deducting the
amount used as reimbursement to the owner, the owner must
promptly refund the full amount of the balance to the family.
5. If the security deposit is not sufficient to cover amounts the family
owes under the lease, the owner may seek to collect the balance
from the family. However, the PHA has no liability or
responsibility for payment of any amount owed by the family to
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the owner.
11. FAMILY RIGHT TO MOVE
a. The family may terminate its lease at any time after the first year of
occupancy. The family must give the owner advance written notice of
intent to vacate (with a copy to the PHA) in accordance with the lease. If
the family has elected to terminate the lease in this manner, the PHA must
offer the family the opportunity for tenant -based rental assistance in
accordance with HUD requirements.
b. Before providing notice to terminate the lease under paragraph a, the
family must first contact the PHA to request tenant -based rental assistance
if the family wishes to move with continued assistance. If tenant -based
rental assistance is not immediately available upon lease termination, the
PHA shall give the family priority to receive the next available
opportunity for tenant -based rental assistance.
12. OVERCROWDED, UNDER -OCCUPIED, AND ACCESSIBLE UNITS
The PHA subsidy standards determine the appropriate unit size for the family size
and composition. The PHA and owner must comply with the requirements in 24
CFR 983.260. If the PHA determines that a family is occupying a wrong -size
unit, or a unit with accessibility features that the family does not require, and the
unit is needed by a family that requires the accessibility features, the PHA must
promptly notify the family and the owner of this determination, and of the PHA's
offer of continued assistance in another unit. 24 CFR 983.260(a).
13. PROHIBITION OF DISCRIMINATION
a. The owner may not refuse to lease contract units to, or otherwise
discriminate against any person or family in leasing of a contract unit,
because of race, color, religion, sex (including sexual orientation and
gender identity), national origin, disability, age or familial status.
b. The owner must comply with the following requirements: The Fair
Housing Act (42 U.S.C. 3601-19) and implementing regulations at 24
CFR part 100 et seq.; Executive Order 11063, as amended by Executive
Order 12259 (3 CFR, 1959-1963 Comp., p. 652 and 3 CFR, 1980 Comp.,
p. 307) (Equal Opportunity in Housing Programs) and implementing
regulations at 24 CFR part 107; title VI of the Civil Rights Act of 1964
(42 U.S.C. 2000d-2000d-4) (Nondiscrimination in Federally Assisted
Programs) and implementing regulations at 24 CFR part 1; the Age
Discrimination Act of 1975 (42 U.S.C. 6101-6107) and implementing
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regulations at 24 CFR part 146; section 504 of the Rehabilitation Act of
1973 (29 U.S.C. 794) and implementing regulations at 24 CFR part 8; title
II of the Americans with Disabilities Act, 42 U.S.C. 12101 et seq. ; 28
CFR part 35; Executive Order 11246, as amended by Executive Orders
11375, 11478, 12086, and 12107 (3 CFR, 1964-1965 Comp., p. 339; 3
CFR, 1966-1970 Comp., p. 684; 3 CFR, 1966-1970 Comp., p. 803; 3
CFR, 1978 Comp., p. 230; and 3 CFR, 1978 Comp., p. 264, respectively)
(Equal Employment Opportunity Programs) and implementing regulations
at 41 CFR chapter 60; Executive Order 11625, as amended by Executive
Order 12007 (3 CFR, 1971-1975 Comp., p. 616 and 3 CFR, 1977 Comp.,
p. 139) (Minority Business Enterprises); Executive Order 12432 (3 CFR,
1983 Comp., p. 198) (Minority Business Enterprise Development); and
Executive Order 12138, as amended by Executive Order 12608 (3 CFR,
1977 Comp., p. 393 and 3 CFR, 1987 Comp., p. 245) (Women's Business
Enterprise).
C. The owner must comply with HUD's Equal Access to HUD -assisted or -
insured housing rule (24 CFR 5.105(a)(2)).
d. The owner must comply with the Violence Against Women Act, as
amended, and HUD's implementing regulation at 24 CFR part 5, Subpart
L, and program regulations.
e. The PHA and the owner must cooperate with HUD in the conducting of
compliance reviews and complaint investigations pursuant to all
applicable civil rights statutes, Executive Orders, and all related rules and
regulations.
14. PHA DEFAULT AND HUD REMEDIES
If HUD determines that the PHA has failed to comply with the HAP contract, or
has failed to take appropriate action to HUD's satisfaction or as directed by HUD,
for enforcement of the PHA's rights under the HAP contract, HUD may assume
the PHA's rights and obligations under the HAP contract, and may perform the
obligations and enforce the rights of the PHA under the HAP contract.
15. OWNER DEFAULT AND PHA REMEDIES
a. Owner default
Any of the following is a default by the owner under the HAP contract:
The owner has failed to comply with any obligation under the HAP
contract, including the owner's obligations to maintain all contract
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units in accordance with the housing quality standards.
2. The owner has violated any obligation under any other housing
assistance payments contract under Section 8 of the United States
Housing Act of 1937 (42 U.S.C. 1437f).
3. The owner has committed any fraud or made any false statement to
the PHA or HUD in connection with the HAP contract.
4. The owner has committed fraud, bribery or any other corrupt or
criminal act in connection with any Federal housing assistance
program.
5. If the property where the contract units are located is subject to a
lien or security interest securing a HUD loan or a mortgage insured
by HUD and:
a. The owner has failed to comply with the regulations for the
applicable mortgage insurance or loan program, with the
mortgage or mortgage note, or with the regulatory
agreement; or
b. The owner has committed fraud, bribery or any other
corrupt or criminal act in connection with the HUD loan or
HUD -insured mortgage.
6. The owner has engaged in any drug -related criminal activity or any
violent criminal activity.
b. PHA remedies
If the PHA determines that a breach has occurred, the PHA may
exercise any of its rights or remedies under the HAP contract.
2. The PHA must notify the owner in writing of such determination.
The notice by the PHA to the owner may require the owner to take
corrective action (as verified by the PHA) by a time prescribed in
the notice.
3. The PHA's rights and remedies under the HAP contract include
recovery of overpayments, termination or reduction of housing
assistance payments, and termination of the HAP contract.
C. PHA remedy is not waived
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The PHA's exercise or non -exercise of any remedy for owner breach of
the HAP contract is not a waiver of the right to exercise that remedy or
any other right or remedy at any time.
16. OWNER DUTY TO PROVIDE INFORMATION AND ACCESS
REQUIRED BY HUD OR PHA
a. Required information
The owner must prepare and furnish any information pertinent to the HAP
contract as may reasonably be required from time to time by the PHA or
HUD. The owner shall furnish such information in the form and manner
required by the PHA or HUD.
b. PHA and HUD access to premises
The owner must permit the PHA or HUD or any of their authorized
representatives to have access to the premises during normal business
hours and, for the purpose of audit and examination, to have access to any
books, documents, papers and records of the owner to the extent necessary
to determine compliance with the HAP contract, including the verification
of information pertinent to the housing assistance payments or the HAP
contract.
17. PHA AND OWNER RELATION TO THIRD PARTIES
a. Injury because of owner action or failure to act
The PHA has no responsibility for or liability to any person injured as a
result of the owner's action or failure to act in connection with the
implementation of the HAP contract, or as a result of any other action or
failure to act by the owner.
b. Legal relationship
The owner is not the agent of the PHA. The HAP contract does not create
or affect any relationship between the PHA and any lender to the owner or
any suppliers, employees, contractors or subcontractors used by the owner
in connection with the implementation of the HAP contract.
C. Exclusion of third -party claims
Nothing in the HAP contract shall be construed as creating any right of a
family or other third party (other than HUD) to enforce any provision of
the HAP contract, or to assert any claim against HUD, the PHA or the
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owner under the HAP contract.
d. Exclusion of owner claims against HUD
Nothing in the HAP contract shall be construed as creating any right of the
owner to assert any claim against HUD.
18. PHA -OWNED UNITS
Notwithstanding Section 17 of this HAP contract, a PHA may own units assisted
under the project -based voucher program, subject to the special requirements in
24 CFR 983.59 regarding PHA -owned units.
19. CONFLICT OF INTEREST
a. Interest of members, officers, or employees of PHA, members of local
governing body, or other public officials
No present or former member or officer of the PHA (except tenant -
commissioners), no employee of the PHA who formulates policy
or influences decisions with respect to the housing choice voucher
program or project -based voucher program, and no public official
or member of a governing body or State or local legislator who
exercises functions or responsibilities with respect to these
programs, shall have any direct or indirect interest, during his or
her tenure or for one year thereafter, or in the HAP contract.
2. HUD may waive this provision for good cause.
b. Disclosure
The owner has disclosed to the PHA any interest that would be a violation
of the HAP contract. The owner must fully and promptly update such
disclosures.
C. Interest of member of or delegate to Congress
No member of or delegate to the Congress of the United States of America
or resident -commissioner shall be admitted to any share or part of this
HAP Contract or to any benefits arising from the contract.
20. EXCLUSION FROM FEDERAL PROGRAMS
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a. Federal requirements
The owner must comply with and is subject to requirements of 2 CFR part
2424.
b. Disclosure
The owner certifies that:
1. The owner has disclosed to the PHA the identity of the owner and
any principal or interested parry.
2. Neither the owner nor any principal or interested party is listed on
the U.S. General Services Administration list of parties excluded
from Federal procurement and non -procurement programs; and
none of such parties are debarred, suspended, subject to a limited
denial of participation or otherwise excluded under 2 CFR part
2424.
21. TRANSFER OF THE CONTRACT OR PROPERTY
a. When consent is required
1. The owner agrees that neither the HAP contract nor the property
may be transferred without the advance written consent of the PHA
in accordance with HUD requirements.
2. "Transfer" includes:
i. Any sale or assignment or other transfer of ownership, in
any form, of the HAP contract or the property;
ii. The transfer of any right to receive housing assistance
payments that may be payable pursuant to the HAP
contract;
iii. The creation of a security interest in the HAP contract or
the property;
iv. Foreclosure or other execution on a security interest; or
V. A creditor's lien, or transfer in bankruptcy.
3. If the owner is a corporation, partnership, trust or joint venture, the
owner is not required to obtain advance consent of the PHA
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pursuant to paragraph a for transfer of a passive and non -
controlling interest in the ownership entity (such as a stock transfer
or transfer of the interest of a limited partner), if any interests so
transferred cumulatively represent less than half the beneficial
interest in the HAP contract or the property. The owner must
obtain advance consent pursuant to paragraph a for transfer of any
interest of a general partner.
b. Transferee assumption of HAP contract
No transferee (including the holder of a security interest, the security
holder's transferee or successor in interest, or the transferee upon exercise
of a security interest) shall have any right to receive any payment of
housing assistance payments pursuant to the HAP contract, or to exercise
any rights or remedies under the HAP contract, unless the PHA has
consented in advance, in writing to such transfer, and the transferee has
agreed in writing, in a form acceptable to the PHA in accordance with
HUD requirements, to assume the obligations of the owner under the HAP
contract, and to comply with all the terms of the HAP contract.
C. Effect of consent to transfer
The creation or transfer of any security interest in the HAP
contract is limited to amounts payable under the HAP contract in
accordance with the terms of the HAP contract.
2. The PHA's consent to transfer of the HAP contract or the property
does not to change the terms of the HAP contract in any way, and
does not change the rights or obligations of the PHA or the owner
under the HAP contract.
3. The PHA's consent to transfer of the HAP contract or the property
to any transferee does not constitute consent to any further
transfers of the HAP contract or the property, including further
transfers to any successors or assigns of an approved transferee.
d. When transfer is prohibited
The PHA will not consent to the transfer if any transferee, or any principal
or interested party is debarred, suspended subject to a limited denial of
participation, or otherwise excluded under 2 CFR part 2424, or is listed on
the U.S. General Services Administration list of parties excluded from
Federal procurement or non -procurement programs.
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(exp. 04/30/2026)
22. SUBSIDY LAYERING
A subsidy layering review is not required for existing housing projects.
23. OWNER LOBBYING CERTIFICATIONS
a. The owner certifies, to the best of owner's knowledge and belief, that:
No Federally appropriated funds have been paid or will be paid, by
or on behalf of the owner, to any person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the
awarding of the HAP contract, or the extension, continuation,
renewal, amendment, or modification of the HAP contract.
2. If any funds other than Federally appropriated funds have been
paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the HAP contract, the
owner must complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
b. This certification by the owner is a prerequisite for making or entering into
this transaction imposed by 31 U.S.C. 1352.
24. TERMINATION OF HAP CONTRACT FOR WRONGFUL SELECTION
OF CONTRACT UNITS
The HAP contract may be terminated upon at least 30 days notice to the owner by
the PHA or HUD if the PHA or HUD determines that the contract units were not
eligible for selection in conformity with HUD requirements.
25. NOTICES AND OWNER CERTIFICATIONS
26.
a. Where the owner is required to give any notice to the PHA pursuant to the
HAP contract or any other provision of law, such notice must be in writing
and must be given in the form and manner required by the PHA.
b. Any certification or warranty by the owner pursuant to the HAP contract
shall be deemed a material representation of fact upon which reliance was
placed when this transaction was made or entered into.
NOTICE OF TERMINATION OR EXPIRATION WITHOUT
Previous editions are obsolete
Project -Based Voucher Program
HAP Contract for Existing Housing
HUD 52530B Page - 20 of Part 2
(4/2023)
Page 230 of 1264
OMB Approval No. 2577-0169
(exp. 04/30/2026)
F,XTF,NSION
a. An owner must provide notice to the PHA, and to the affected tenants, not
less than 1 year prior to the termination or expiration without extension of
a HAP contract.
b. An owner who fails to provide such notice must permit tenants to remain
in their units for the required notice period with no increase in the tenant
portion of the rent. During this time period, an owner may not evict a
tenant as a result of the owner's inability to collect an increased tenant
portion of rent. With PHA agreement, an owner may extend the
terminating contract for a period of time sufficient to give tenants 1 year
advance notice.
27. FAMILY'S RIGHT TO REMAIN
Upon termination or expiration of the contract without extension, each family
assisted under the contract may elect to use its assistance to remain in the project
if the family's unit complies with the inspection requirements under section
8(o)(8) (42 U.S.C. 1437f(o)(8) of the U.S. Housing Act of 1937 ("the 1937
Act")), the rent for the unit is reasonable as required by section 8(o)(10)(A) of the
1937 Act, and the family pays its required share of the rent and the amount, if
any, by which the unit rent (including the amount allowed for tenant -paid utilities)
exceeds the applicable payment standard.
28. ENTIRE AGREEMENT; INTERPRETATION
a. The HAP contract, including the exhibits, is the entire agreement between
the PHA and the owner.
b. The HAP contract must be interpreted and implemented in accordance
with all statutory requirements, and with all HUD requirements, including
amendments or changes in HUD requirements during the term of the HAP
contract. The owner agrees to comply with all such laws and HUD
requirements. Any regulatory citation specifically included in this HAP
contract is subject to any subsequent revision of such citation.
Previous editions are obsolete
Project -Based Voucher Program
HAP Contract for Existing Housing
HUD 52530B Page - 21 of Part 2
(4/2023)
Page 231 of 1264
PBV HOUSING ASSISTANCE PAYMENTS CONTRACT
[7_T:�I
EXHIBIT A
Description of Housing Includes:
1. Project Site: Rose of Dubuque Senior Affordable Assisted Living Center
a. Site address will be: 3390 Lake Ridge Drive, Dubuque, IA 52003
b. Legal Description:
. Lot 1, Cedar Lake Plaza Fouth Addition
2. Total Number of Units in Facility — Rose of Dubuque Senior Affordable Assisted Living Center will have a
total of 70 Units. The unit breakdown and unit size is as follows:
a. 64 Units are 1-Bedroom — Each 728 Avg. SF in Size
b. 6 Units are 2- Bedrooms— Each 849 Avg. SF in Size
3. Total Number of Contract Units Covered By HAP Contract Agreement — 17 Units (Exhibit A.1.).
4. Location of Contract Units on Site — All 17 Units will be fixed within the 70 unit Rose of Dubuque Senior
Affordable Assisted Living Center.
5. Estimated Initial Rent — Based on the Current Prevailing Fair Market Rents:
a. 1- Bedroom - $948 per month
6. Services, Maintenance and Equipment Supplied to each Unit — See Attached Standard form of Lease
(Exhibit A.2.).
7. Utilities Available — All utilities included in rent, except for Phone and Cable Services — See Attached
Standard form of Lease(Exhibit A.2.).
8. HAP Contract Term — 1 year from Commencement of HAP Contract.
Page 232 of 1264
EXHIBIT A. I.
Rose of Dubuque
Project Based Section 8 Units
203
204
207
209
214
216
224
229
303
304
307
309
314
315
316
324
329
Page 233 of 1264
EXHIBIT A.2.
Number of Bedrooms: «bedrooms»
Annual Recertification Date: «recertification date»
LEASE FOR THE ROSE OF DUBUQUE
Equal Opportunity Housing
PARTIES AND DWELLING UNIT: The parties to this Lease are THE ROSE OF
DUBUQUE, L.P. referred to as "Landlord," and ohead_name>> «spouse name»
ocotenant_name 1», referred to as "Tenant." The Landlord leases to the Tenant
Apartment Dwelling « apt_nbm located at 3390 Lake Ridge Drive, Dubuque, Iowa 52003
(hereafter "unit"). EverGreen Real Estate Development Corporation is the management
agent authorized to act on behalf of Landlord, including receipt of rental payments and
receipt of service of process and notices and demands. The address of EverGreen Real
Estate Development Corp. for receipt of service of process and notices and demands is
16670 Franklin Trail, Ste 240, Prior Lake, MN 55372.
The premises leased are for the exclusive use and occupancy of the Tenant's household,
consisting of the following -named persons who will live in the dwelling unit:
_Aead_name»_«spouse_name»_«cotenant name 1)>
The Tenant has designated as his or her legal
representative. Upon written request, the legal representative will be provided with a
copy of the Lease and notice of any change in the terms of the Lease or initiation of an
involuntary transfer, if applicable.
2. LEASE TERM AND RENT PAYMENT: This Lease shall begin on «lease start date».
The initial term shall be , beginning on «lease start date, and
ending on please end date», unless terminated as provided by this lease. After the initial
term ends, the Lease may be renewed for successive one month terms, except that at each
point of renewal, Landlord may change the lease terms, including rent, as provided in
paragraph 20. Landlord may review and update the Lease as necessary to reflect any
changes in Tenant's financial arrangements and service plan as set forth in the Service
Plan Agreement.
3. RENT: A Tenant shall pay monthly rent of «basic rent. This amount is due on the first
day of each month at the offices of The Rose of Dubuque, 3390 Lake Ridge Drive,
Dubuque, IA 52003. All payments by tenant shall be applied first to past due rent and
past due additional rent (see paragraph 4) before being credited to a current month's rent
or current additional rent. If, at the commencement of this lease, the Tenant is leasing the
unit after the first of the month, the rent for the first partial month is <<prorategent»,
prorated from «lease_ start _date>> to <dast_day_of month. While it is the Tenant's
responsibility to pay rent, the obligation to pay rent may be satisfied through third party
payments arranged in advance with Landlord.
4. ADDITIONAL RENT FOR LATE PAYMENTS, RETURNED CHECKS OR OTHER_
PROPERTY CHARGES: If the Tenant does not pay the full amount of the rent shown in
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paragraph 3 by 5:00 p.m. on the fifth day of the month, the Landlord may collect a fee of
$10.00 on the fifth day of the month. Thereafter, the Landlord may collect $5.00 for each
additional day the rent remains unpaid during the month up to a maximum of $60.00.
The Landlord may collect a fee of $30.00 any time a check is not honored for payment
(bounces). If a Tenant elects to subscribe to a food plan offered by Management Agent,
to rent a personal emergency response system pendant from Landlord or to enroll in the
in-house basic service plan fee agreement with the Rose service provider, the fees or
charges for those elections shall be considered additional rent under this Lease.
Additional rent shall also include other charges accruing under this Lease, which include
repair charges for excess wear and tear, lost key charges, and other reasonable charges.
The charges referenced in this paragraph 4 are deemed additional rent payable with the
current month's rent referenced in paragraph 3.
5. OPTIONAL SERVICES: If Tenant is in need of services, the Tenant may elect to
receive services from Landlord, Landlord's non-exclusive, on -site Service Provider, or
another authorized Service Provider designated by Tenant; said services are more
specifically set forth in the Service Plan Agreement, which is included in Tenant's
Occupancy Agreement. The costs for such optional services shall be in addition to the
Rent for the Apartment Dwelling and such costs are more specifically set forth in the
Service PIan Agreement. The choice of a Service Provider is Tenant's right; any Service
Provider chosen by Tenant must execute an Assisted Service Program Agreement with
Landlord and a Service Plan Agreement with Tenant and Landlord. Tenant must choose
a Service Provider as a condition of residency, and a failure to have a contracted Service
Provider and maintain a Service Plan Agreement is deemed a material breach of this lease
and grounds for termination of this lease.
6. DEPOSITS:
a. SECURITY DEPOSIT: The Tenant has deposited $� with the Landlord
towards their $1000.00 security deposit and, if the deposit is not paid in fall at
Move -in, Tenant agrees to enter into a payment agreement for the remainder of
the security deposit, which agreement is incorporated into and made a part of this
Lease.
b. PET DEPOSIT: Yes No If Tenant has initialed the "Yes" blank, the
Tenant has deposited $500.00 as a pot security deposit with the Landlord as a
condition of his or her having an authorized and documented pet in the unit;
except that Landlord shall permit emotional support or service animals
documented to assist a tenant with a disability, and such animals are exempted
from the requirements of the Pet Deposit as required by law. Landlord may
charge Tenant for damage to the common areas or to the unit and for additional
cleaning caused by the presence of an animal, beyond ordinary non -animal wear
and tear, including retention of the Pet Deposit, if applicable. No other animals
are allowed anywhere on the premises without the express written consent of
Landlord. Proof of current vaccinations is required for any animal on the
premises.
C. The Landlord will hold the Deposit(s) for the period the Tenant occupies the unit.
The Landlord shall not use the Deposit(s) for rent or other charges while the
Tenant is living in the unit. After the Tenant has moved out of the unit and given
ON
Page 235 of 1264
Tenant's new address or delivery instructions to the Landlord, the Landlord shall
return the Deposit(s), in accordance with Iowa Code Chapter 562A.12, minus
whatever amount is needed to pay the cost of-
( i) Unpaid rent;
( ii) Repair of damages that exceed normal wear and tear as listed on the
Move -Out Unit Inspection Report;
(iii) Additional rent charges as described in paragraph 4, if any remain unpaid;
( iv) Charges for unreturned keys, as described in paragraph 11;
( v) Charges for elective services provided to Tenant by Landlord or
Management Agent; and
(vi) Other charges due under the lease.
After the Tenant has moved from the unit, the Landlord will inspect the unit and
complete the Move -Out Apartment Inspection Report, which is attached to this Lease as
Attachment No. 1. The Landlord shall provide the Tenant with a written list of any
charges made against the Deposit(s), including any charges associated with the Move -Out
Apartment Inspection Report. If the Tenant disagrees with the amount subtracted from
the Deposit(s), the Landlord agrees to meet with the Tenant to discuss the changes.
If more than one person rents the unit, the Tenants agree they will assume all
responsibility for dividing any refund among themselves. The Landlord may pay the
refund to any Tenant identified in paragraph I of this Agreement, without further liability
to the Tenants.
If no mailing address or delivery instructions are provided to the Landlord within one
year from termination of the tenancy, the deposit shall revert to the Landlord and the
Tenant will be deemed to have forfeited all rights to the deposit.
7. ANNUAL CERTIFICATION OF FAMILY COMPOSITION AND HOUSEHOLD
INCOME: Landlord is participating in the Low Income Housing Tax Credit Program,
which mandates that Tenant households satisfy certain income eligibility requirements as
a condition for initial occupancy. The Tenant acknowledges that his or her family
income, family composition, or other eligibility requirements may be considered material
in determining the Tenant's right to initial occupancy. Upon each annual anniversary of
the Tenant's lease commencement, or upon other reasonable request by Landlord, within
thirty days of Landlord's request, the Tenant shall provide accurate statements regarding
income, assets, expenses and family compositions. The Landlord shall verify the income
supplied by the Tenant. In the event that federal laws or regulations or state statues or
rules require the Landlord to obtain additional information throughout the year regarding
the Tenant's family income, family composition or other eligibility requirements, the
Tenant agrees to provide such required information within seven days of the request from
the Landlord. In addition, Tenant affirmatively agrees to notify Landlord if Tenant or a
member of Tenant's household becomes a full-time student or Tenant experiences any
other material change in Tenant's household. A Tenant's failure to provide any
information referenced in this paragraph shall be grounds for termination of this lease.
Page 236 of 1264
8. CONFIDENTIALITY. The contents of Tenant's files shall be confidential and Landlord
and Service Provider's staff shall maintain that confidentiality as permitted or required by
applicable law or regulation. Tenant authorizes Landlord and Service Provider each to
have open access to the other's respective files. Release of information to third parties
must be requested in writing by third parties and authorized in writing by Tenant.
9. CONDITIONS OF OCCUPANCY, ADMISSION AND TRANSFER: The Tenant must
live in the unit and the unit must be the only place of residence. The Tenant shall use the
premises solely as a private dwelling for himself or herself and the persons named in
paragraph 1 of this Lease, and shall not permit its use for any other purpose. Tenant may
not use the unit as a site for conducting any business that would require customers or
vendors to come to the unit. As long as Tenant abides by the terms of this Lease, Tenant
shall have the right to exclusive use and quiet enjoyment of the unit.
Prior to occupancy, the Landlord's non-exclusive, on -site Service Provider shall evaluate
each proposed Tenant's functional, cognitive and health status in order to determine the
Tenant's eligibility for residency at the Development, including whether services required
by Tenant's unique physical, mental and emotional condition can be provided by a
Service Provider of Tenant's choice. The functional, cognitive and medical admission
criteria are itemized in the Admission/Transfer Policy, which is included in Tenant's
Occupancy Agreement. It is Tenant's responsibility to select a Service Provider of their
choice to administer any services that Tenant requires and monitor Tenant's continued
needs. A failure of a Tenant to choose, contract with and maintain a contract with a
Service Provider of their choice is a material breach of this lease, and will be grounds for
termination of the Tenant's lease. The Service Provider selected by Tenant shall monitor
Tenant's condition during Tenant's occupancy. It is Tenant's responsibility to notify
their Service Provider and Landlord of any hospitalizations or other extended absences
from the Rose community and immediately inform their Service Provider and Landlord
upon their return. Any change in Tenant's condition that results in a violation of the
Admission/Transfer Policy constitutes grounds for termination of this Lease and will
result in the transfer of Tenant to another housing arrangement that can accommodate
Tenant's needs.
In the event Tenant disagrees with Landlord's request for transfer for conditions stated in
the Admission/Transfer Policy, Tenant and Tenant's legal representative may contest the
transfer as provided in the Admission/Transfer Policy — Appeal Procedure.
Landlord and Service Provider shall not discriminate or retaliate in any way against a
Tenant, a Tenant's family, or an employee of Landlord or Service Provider who has
initiated and participated in any proceeding authorized by Iowa Code, Chapter 231C —
Assisted Living Programs. Any such discrimination or retaliation will subject the
violator to a penalty as established by administrative rule and enforced by the Department
of Inspections and Appeals.
This Lease is subject to the Iowa Uniform Residential Landlord and Tenant Law, Iowa
Code Chapter 562A and the provisions of Iowa Code Chapter 648, Forcible Entry and
4
Page 237 of 1264
Detention to Real Property, and the rights and remedies provided Landlords and Tenants
thereunder.
10. GENERAL RESTRICTIONS: The Tenant shall not:
a. Permit any person other than those listed above and minor children which are
born into this household during this tenancy, to reside in the unit without
obtaining the prior written approval of the Landlord. Tenant may have house E
guests for reasonable stays. A reasonable stay shall not exceed two consecutive
days (without management permission) nor an aggregate of fourteen (14) days f
total in any one year period. House guests staying beyond fourteen (14) days in a
one year period shall be reported to Landlord as additional household members
and all Tenant eligibility rules and regulations will be applicable to the addition of
a new household member;
b. Sublet or assign the unit, or any part of the unit; i
C. Use the unit for any unlawful purposes. The Tenant hereby specifically covenants
and agrees that she/he will not use the unit, the common areas, or the development
grounds, or permit anyone acting under his/her direction or control or present at
his/her invitation to use the unit, common areas, or development grounds to (i)
i
manufacture, sell, give away, barter, deliver, exchange, distribute, use or possess
with intent to manufacture, sell, give away, barter, deliver, exchange, distribute,
or use a controlled substance in violation of the Iowa Code. (ii) allow prostitution
or prostitution -related activity; (iii) allow the unlawful use or possession of a
firearm in violation of The Iowa Code ; (iv) allow possession of stolen property or
property obtained by robbery. The Tenant hereby acknowledges that a breach of
the covenant contained in this paragraph I Oe voids his/her right to possession of
the unit and is good cause for termination of this lease;
d. Have pets or animals of any kind anywhere on the premises or in their apartment,
excepting only documented emotional support or service animals or pets to which
Landlord has specifically consented, with payment of the appropriate Pet Deposit 1
and liquidated damages;
e. Act or allow household members or guests to act in a manner that will disturb the
rights and comfort of neighbors. The Tenant agrees to keep the volume of any 1
radio, stereo, television, or musical instruments at a level that will not disturb the
neighbors;
f. Permit any member of the household, a guest, or another person under the
Tenant's control to engage in any criminal activity that threatens the health, safety
or right to peaceful enjoyment of the premises by other residents or employees; f
g. Use or permit the use of Christmas decorations that are not flame retardant;
h. Use candles, incense, or any other open flame or incendiary articles or accents
within the unit or on the premises;
i. Engage in SMOKING except in designated exterior areas;
j. Engage in VAPING except in the tenant's apartment or in designated exterior
areas; and
k. Engage in conduct prohibited elsewhere in this lease.
5
Page 238 of 1264
It is specifically agreed that violation of the above restrictions constitute material
noncompliance with this lease and entitle Landlord to terminate this lease as provided in
Section 21.
11. KEYS AND LOCKS: The tenant agrees not to install additional or different locks or
gates on any doors or windows of the unit without written permission of the Landlord. If
the Landlord approves the Tenant's request to install such locks, the Tenant agrees to
provide the Landlord with a key for each lock. At the termination of this Lease, the
Tenant agrees to return all keys to the Landlord. The Landlord may charge the Tenant
$50.00 for each key not returned and deduct such amount from security deposit as
provided in paragraph 6. If Tenant fails to return any keys to Landlord, at its sole
discretion, deems it necessary for a subsequent Tenant's security to re -key the locks, the
charge for such action shall be deducted from the security deposit as provided in
paragraph 6.
12. RULES AND REGULATIONS: Tenant agrees to obey the Rules and Regulations of The
Rose, which is included in Tenant's Occupancy Agreement. Tenant agrees that the Rules
and Regulations apply to all members of the household and guests and agrees that
Management may exclude Tenant's guests from the premises and Tenant's unit for
violations of said rules and policy. Allowing excluded persons onto the premises shall be
considered a lease violation. The Tenant agrees to obey additional rules established after
the effective date of this lease Agreement if:
a. The rules are reasonably related to the safety, care and cleanliness of the building
and safety, comfort and convenience of the Tenants; and
b. A Tenant receives written notice of the proposed rule at least 30 days before the
rule is enforced.
13. CONDITION OF UNIT: By signing this Lease and the Move -in Apartment Inspection
Report, the Tenant acknowledges that the unit is safe, clean and in good condition, and
that all appliances and equipment in the unit are in good working order as described on
the Move -in Apartment Inspection Report, which is attached to this Lease as Attachment
No. 1. The Tenant agrees that the Landlord has made no promises to decorate, alter,
repair or improve the unit except as listed on the Move -in Apartment Inspection Report.
At the time of move -out, the Landlord shall complete another inspection of the unit and
complete a Move -out Apartment Inspection Report, which is attached to this Lease as
Attachment No. 1.
14. UTILITIES: The following chart describes how the cost of utilities and services for the
unit shall be paid. The Landlord shall not be responsible for failure to furnish utilities for
reasons that are beyond the Landlord's control.
Type of Utility Landlord Paid Tenant Paid
Gas (Room heat and water heat) X
Household Electricity X
Water and sewer X
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Trash removal X
Phone X
Cable X
15. MAINTENANCE:
TENANT AGREES TO:
a. Deep the unit and other areas assigned for the Tenant's exclusive use in a clean
and safe condition:
b. Use all appliances, fixtures and equipment in a safe manner and only for the
purposes for which they are intended;
C. Not litter the grounds or common areas of the development;
d. Not undertake, or permit his or her family or guest to undertake any hazardous
acts or do anything that will damage the property;
e. Not destroy, deface, damage or remove any part of the unit, common areas, or
development grounds;
£ If requested to do so, separate recyclable materials from other trash and place
trash and recyclables in appropriate containers for refuse pick-up;
g. Remove garbage and other waste from the unit in a clean and safe manner. All
trash should be placed in sealed plastic garbage bags and placed in trash
receptacles provided by Landlord;
h. Give the Landlord prompt notice of any defects in the plumbing, fixtures,
appliances, heating and cooling equipment or any other part of the unit or related
facilities;
i. Not store items outside his or her unit or in the hallway;
j. If Tenant has an authorized service animal or pet, Tenant agrees to clean up
animal waste from the apartment and common areas and properly dispose of
same;
k. Pay reasonable charges for the repair of damages (in excess of normal wear and
tear) to the unit, development buildings, facilities or other common areas caused
by the Tenant, his/her household, or guests, and to do so within 30 days after
receipt of Landlord's itemized statement for the repair charges. Normal wear and
tear does not include pest eradication attributable to Tenant. Normal wear and
tear does not include damages attributable to mobility assistance devices, such as
wheel chairs, motorized scooters, walkers, canes and other such devices. Normal
wear and tear does not include damages attributable to Tenant's having a pet in
the apartment. A Damage and Service Charge Schedule may be obtained from
Landlord's office.
LANDLORD AGREES TO:
a. Maintain the common areas, facilities, grounds and the development in a decent,
safe and sanitary condition;
b. Comply with requirements of applicable health and safety laws, building codes
and housing codes;
C. Make necessary repairs to the premises and maintain exterior common area
lighting in good working order;
7
Page 240 of 1264
d. Maintain in good and safe working order and condition electric, plumbing,
sanitary, heating, ventilating, and other facilities and appliances supplied or
required to be supplied by the Landlord;
C. Provide appropriate garbage receptacles and recycling bins (if recycling is
accepted by the refuse vendor) for the deposit of garbage, rubbish and other
wastes removed from the unit by the Tenant and arrange for collection and
removal of trash and garbage;
f Provide exterminator services, excepting pest eradication charges attributable to
Tenant, as necessary;
g. Supply sewer and water services, hydronic heat and electrical service;
h. Provide snow removal from the parking lot and sidewalks.
16. DAMAGES: When damage is caused to the Tenant's unit, exterior building or common
area and facilities by carelessness, misuse or neglect on the part of the Tenant or Tenant's
family or visitors, the Tenant agrees to pay:
a. The cost of all repairs within 30 days after receipt of the Landlord's demand for
repair charges; and.
b. Rent for the period the unit is damaged whether or not the unit is habitable.
IT RESTRICTIONS ON ALTERATIONS: The Tenant shall not do any of the following
without first obtaining the Landlord's written permission:
a. Dismantle, change or remove any part of the appliances, fixtures or equipment in
the unit;
b. Paint or install wallpaper or contact paper in the unit;
C. Install curtains or draperies in the unit;
d. Attach awnings or window guards in the unit;
e. Attach or place any fixtures, signs or fences on the building(s), the common areas
or the Development grounds;
f. Attach any shelves, screen doors or other permanent improvements in the unit;
g. Install or alter carpeting, resurface floors or alter woodwork;
h. Install washing machines, driers, fans, heaters or air conditioners in the unit;
i. Place any aerials, antennas or other electrical connections on the unit; satellite
dishes may not be installed unless approved in accordance with the Management
Satellite Dish Policy.
j. Install additional or different locks or gates on any door or windows of the unit; or
k. Other:
18. ACCESS BY LANDLORD: Landlord shall provide 24 hour or other reasonable advance
notice to the Tenant of its intent to enter the unit for the purposes of performing
inspections, for making improvements or repairs, for supplying necessary or agreed
services, or to show the unit for re -renting. The Tenant shall permit the Landlord, its
agents, or other persons, when accompanied by the Landlord, to enter the unit for these
purposes. In the event the Tenant and the adult members of the household are absent
from the unit at the time of entry, the Landlord shall leave a card stating the date and time
and name of the person entering the unit and the purpose of the visit.
s
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The Landlord may enter the unit at any time without advance notice when there is
reasonable cause to believe an emergency exists, or after receiving a call in the office that
a repair needs immediate attention.
Tenant consents to access by Landlord, its agents, or other persons for purposes of
supplying necessary or agreed to services as reflected in the Tenant's Service Plan
Agreement.
19. DISCRIMINATION PROHIBITED: The Landlord agrees not to discriminate based upon
race, color, religion, creed, national origin, sex, age, disability, sexual orientation, gender
identity, familial status, membership in a class, such as unmarried mothers or recipients
of public assistance, or because there are children in the family.
20. CHANGE IN LEASE: The Landlord may change the terms and conditions of this Lease
at the end of the initial term or a successive term. The Landlord must notify the Tenant
of any change and must offer the Tenant a new Lease or an amendment to the existing
Lease. The Landlord shall provide Tenant or the Tenant's representative at least 30 days
notice before the proposed effective date of the change. The Tenant may accept the
changed terms and conditions by signing the new Lease or the amendment to the existing
Lease and returning it to the Landlord. The Tenant may reject the changed terms and
conditions by giving the Landlord written notice that Tenant intends to terminate the
tenancy. The Tenant must give such notice of rejection at least 30 days before the month
in which the tenancy will be terminated. If the Tenant does not accept the amended
Lease, the tenancy will cease at the end of the lease term. An exception to the 30 day
notice exists when the Tenant's health status or behavior constitutes a substantial threat to
the health and safety of the Tenant, other Tenants, or staff of Landlord or Service
Providers or when a significant change in the Tenant's condition results in the need for
provision of services in excess of the level of services provided by a Service Provider and
which cannot be safely and competently provided by a Service Provider, as explained in
greater detail in Section 9, and the Admission/Transfer Policy.
21. TERMINATION OF TENANCY:
a. Where the Tenant is authorized by the terms of this Lease to terminate this Lease,
the Tenant must give the Landlord 30 days written notice prior to the end of the
lease term. The 30 days written notice shall be calculated from the last day of the
month in which notice is given. If the Tenant does not give the full 30 day notice,
the Tenant shall be liable for an additional month's rent, or to the date the unit is
re -rented, whichever date comes first.
b. Any termination of this Lease by the Landlord must be carried out in accordance
with state and local law, and the terms of this Lease. The Landlord may terminate
this Lease for:
(1) Non-payment of rent, additional rent charges, other charges, and fees due
under the Lease, or repeated late payment of rent; and
(2) Failure to provide timely and accurate statements of income, assets,
expenses and family composition at the commencement of the initial term
of the Lease or at an annual rent certification upon any lease renewals or
Page 242 of 1264
in response to other reasonable request by Landlord;
(3) Demonstrating behavior or conditions referenced in the Admission/
Transfer Policy;
(4) Failure to participate in bimonthly fire drills and evacuation training and
to follow evacuation procedures when emergency circumstances arise;
(5) Assignment or subleasing of the premises or providing accommodation for
boarders or lodgers;
(6) Use of the premises for purposes other than solely as a dwelling unit for
the Tenant and the Tenant's household as identified in this Lease, or
permitting its use for any other purpose;
(7) Failure to abide by necessary and reasonable rules made by the Landlord
for the benefit and wellbeing of the development and the Tenants,
including repeated violations of the Rules and Regulations of The Rose
included in Tenant's Occupancy Agreement;
(8) Failure to abide by applicable building and housing codes materially
affecting health or safety;
(9) Failure to dispose of garbage, waste or rubbish in a safe and sanitary
manner and as provided in this Lease;
(10) Failure to use electrical, plumbing, sanitary, heating, ventilating, air
conditioning and other equipment in a safe manner;
(11) Acts of destruction, defacement, or removal of any part of the premises, or
failure to cause guests to refrain for such acts;
(12) Failure to pay reasonable charges within 30 days for the repair of damages
(other than for normal wear and tear) to the premises, development
buildings, facilities or common areas;
(13) Serious or repeated interference of the rights and quiet enjoyment of other
Tenants;
(14) Any criminal activity that threatens the rights and quiet enjoyment of other
Tenants;
(15) Any drug -related criminal activity on or near the premises as discussed
elsewhere in this Lease;
(16) Change in Tenants' household so that Tenant or a member of Tenant's
household becomes a frill -time student, which status would cause non-
compliance of the development under state or federal statutes or
regulations;
(17) Violations of paragraph 10c of this Lease;
(18) Allowing access to the premises to persons excluded by Management;
(19) Violations of any provision of this Lease, including the prohibition against
pets or smoking and the limitations on vaping; and
(20) For other good cause.
C. If the Landlord proposes to terminate this Lease, the Landlord agrees to give the
Tenant written notice of the proposed termination, as listed below:
(1) Failure to pay rent, three days written notice of nonpayment and intention
to terminate Lease if not paid within three days, all as provided by Iowa
Code §562A.27(2);
(2) Creation or maintenance of behavior or threats, including behaviors under
10
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the Admission Transfer Policy, constituting a clear and present danger to
health or safety of the Tenant, other Tenants or Landlord's employees or
contract agents, three days written notice of termination and notice to quit;
(3) Demonstrating behavior or conditions referenced in the Admission/
Transfer Policy, which fall short of a clear and present danger to health
and safety of the Tenant, other Tenants or Landlord's employees or
contract agents, seven (7) days written notice of termination and notice to
quit, same as provided in (4) below;
(4) All other cases of material noncompliance with the Lease, seven (7) days
written notice, which notice shall specify the actions and omissions
constituting the breach of lease and specify that the rental agreement will
terminate upon a date not less than seven (7) days after receipt of the
notice if the breach is not remedied in the seven day period. If remedied,
the lease shall not terminate. If substantially the same act or omission,
which constituted the noncompliance, recurs within six months, Landlord
may terminate the lease upon seven (7) days written notice specifying the
recurrent breach and the date of termination;
(5) In all other cases, including non -renewal, written notice provided thirty
(30) days prior to the end of the term of the tenancy.
d. If Tenant refuses to vacate their apartment after termination of the lease, Landlord
will provide Tenant with a three days' notice to quit and proceed with a forceable
entry and detainer action.
22. REMEDIES OF LANDLORD UPON TERMINATION — EXPENSES DAMAGES
DEFICIENCIES, ETC:
In the event that the Term of this Lease shall terminate other than by expiration:
a. Tenant shall pay to the Landlord the rent and fees then due, together with all
legally recoverable expenses of the Landlord incurred in connection with (i) any
lawful action or proceeding that results in an order of a court that Tenant shall
surrender possession of the unit; and (ii) the removal of the property and effects of
Tenant or other occupants from the unit.
b. Tenant shall be liable for all expenses incurred by Landlord in repairing and
redecorating the unit for re -rental with the exception of ordinary wear and tear;
C. Landlord may release the unit in the name of the Landlord for a term which may
at Landlord's option be more or less than the period which would otherwise have
constituted the balance of the Term of this Lease, and Tenant shall remain liable
for payment of the full rent for any period of the balance of the lease during which
the unit was not released;
d. Landlord shall not be liable to Tenant for failure to release the unit or, in the event
that the unit is re -rented, for failure to collect the rent due under such re -renting.
Any such failure to collect the rent due under such re -renting shall not release or
affect Tenant's liability for damages;
e. Landlord's rights and remedies under this Agreement are cumulative. The use of
one or more right or remedy shall not exclude or waive any other right or remedy.
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23. TENANT'S RIGHTS/GRIEVANCES. Tenant is advised that this Lease and
Tenancy's occupancy is subject to the Iowa Residential Landlord and Tenant Law, Iowa
Code Chapter 562A, et seq. Tenant has rights of internal appeal as defined in the
Admission/Transfer Policy, but only in the event Landlord seeks to involuntarily transfer
Tenant for reasons stated in the Admission/Transfer Policy. If the Tenant's residency is
terminated for reasons other than those stated in the Admission/Transfer Policy, Tenant's
rights upon termination and forced eviction are defined in Sections 21 and 22 of this
Lease Agreement. Tenants are encouraged to present any concerns regarding their
residency or assisted care service to property management or the assisted care provider.
These concerns are best presented in writing to the on -site resident manager, the on -site
assisted care manager or your assigned assisted care worker. Tenant concerns presented
in writing will be investigated and a written response will be provided to the Tenant and a
copy placed in the tenant file. Tenant has rights of autonomy and self determination with
respect to the service plan. These rights are discussed in greater detail in the Risk
Management Policy and Tenant's Rights and Responsibilities, which are included in
Tenant's Occupancy Agreement. Concerns, questions or complaints regarding any aspect
of Tenant's residency or service plan may also be addressed with his/her designated legal
representative, the Office of the State Long -Term Care Ombudsman, 866-236-1430, or
the Iowa Department of Inspections and Appeals (515) 281-3425. The Landlord will
notify the tenant at least 90 days in advance of any planned program cessation, which
includes voluntary decertification, except in cases of emergency.
24. TERMINATION OF LEASE UPON DEATH OF TENANT: Upon the death of the
Tenant, or if there is more than one Tenant, upon the death of all Tenants, either the
Landlord or the personal representative of the Tenant's estate may terminate this Lease
upon one months' written notice before the beginning of a monthly term. The
termination of this Lease shall not relieve the Tenant's estate from liability either for the
payment of rent, additional rent or other sums owed prior to or during the notice, or for
the payment of amounts necessary to restore the unit to its condition at the
commencement of the tenancy, ordinary wear and tear excepted.
25. PROPERTY ABANDONMENT: Tenant agrees to notify Landlord of any anticipated
extended absence in excess of 14 days within one day of the beginning of the extended
absence. If tenant is absent from the unit in excess of 14 days, Landlord may enter the
unit to determine whether Tenant has abandoned the unit. If at any time (regardless of
whether the Tenant has been absent for 14 days), it reasonably appears that Tenant has
abandoned the unit and Tenant has failed to communicate with Landlord regarding
Tenant's absence, Landlord may proceed as if Tenant has abandoned the unit and any
property present in the unit and accept the abandonment as a surrender of possession of
the unit by the Tenant and an immediate termination by the Tenant of the lease. In such
an instance of abandonment, the Landlord shall take possession of the Tenant's personal
property remaining on the premises and proceed to sell or otherwise dispose of the
property. Landlord may, but is not obligated to, sell the abandoned personal property, and
instead, may dispose of the personal property in any manner chosen by Landlord. Prior
to the disposal or sale of abandoned property, the Landlord agrees to make reasonable
efforts for an additional 7 days after Landlord's initial determination of abandonment to
notify the Tenant or Tenant's legal representatives of the pending disposal or sale by use
of whatever means of communication is deemed appropriate and effective for the purpose
12
Page 245 of 1264
of contacting Tenant or Tenant's legal representatives. The Landlord may use the money
from the disposal or sale to pay off any debts the Tenant owes the Landlord. Any amount
above this belongs to the Tenant if the Tenant contacts Landlord and asks for it.
The Landlord may also, at its election, attempt to re -rent the abandoned unit, although the
Landlord is under no obligation to do so, and Tenant therefore remains obligated for
payment of rent for the duration of the Lease.
26. NOTICE OF POTENTIAL OFFER OF NON -ACCESSIBLE UNIT: If Tenant is renting a
unit that is deemed accessible to handicapped/disabled individuals, and Tenant or one of
Tenant's household are not disabled, the LIHTC/HOME Programs requires that in the
event that the accessible unit is needed by a person/household with a disability and a
similar non -accessible unit is available at the property at the same rent as the accessible
unit, Landlord has the right to ask Tenant to move to a comparable non -accessible unit.
Whether Tenant elects to move to the non -accessible unit remains the tenant's choice but
the offer to move will be made to Tenant and Tenant's household.
27. CONTENTS OF THIS LEASE: This Lease and its attachments make up the entire
agreement between the Tenant and the Landlord. If any court declares a particular
provision of this Lease to be invalid or illegal, all other terms of this Lease will remain in
effect and both the Landlord and Tenant will continue to be bound by it.
28. SUBORDINATION: This Lease is subject to all present or future mortgages affecting the
unit, and the Tenant hereby appoints the Landlord as Attorney -in -Fact to execute and
deliver any and all necessary documents to subordinate this Lease to any present or future
mortgage affecting the unit.
29. WAIVER OF ONE BREACH NOT A GENERAL WAIVER• ACCEPTANCE OF
RENT - NOT A WAIVER OF EXISTING OR PRIOR BREACHES: A waiver of a
breach of the covenants, provisions or conditions contained in this Lease shall not be
construed as a waiver of the covenant itself or of any subsequent breach thereof If any
breach shall occur and afterwards be compromised, settled or adjusted, this Lease shall
continue in full force and effect as if no breach had occurred. Acceptance of rent from
Tenant does not constitute a waiver by Landlord of any existing, pending or prior
breaches of this Lease by Tenant.
30. PERSONAL PROPERTY/STORAGE/PARKING/SNOW REMOVAL:
a. All personal property placed in the unit or in any other portion of a building or the
development shall be at the sole risk of the Tenant. The Landlord shall not be
liable for the loss, destruction, theft, or damage to such property under any
circumstances. The Tenant is encouraged to obtain renter's insurance for their
personal property and contents.
b. Storage: The Tenant agrees not to store flammable materials or liquids or any
other item that would create a danger to the other Tenants or to the development.
It is specifically understood that Tenant shall not store items outside his or her
13
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unit, in the hallway, or in the proximity of their unit.
C. Parking: Parking is allowed in designated parking areas only. Vehicles parked in
the apartment roadway in areas not designated for parking, will be towed at the
vehicle owner's expense. Tenant must register with Management all vehicles
that will be parked in the exterior designated parking areas for periods in excess
of 24 hours. Parking for additional vehicles must be approved by Landlord or be
subject to towing at the owner's expense. Any vehicle parked in a designated
parking area must be in operating condition and have current license plates and
tabs.
d. Snow Removal: Snow removal procedures for the exterior parking area will be
posted on the premises and must be followed exactly. Failure to do so will result
in the towing of violating vehicles.
31. CONDEMNATION: In the event the unit, the building, the development or any part
thereof is taken by condemnation by the United States, the State of Iowa, or any other
governmental agency or authority, this Agreement shall be terminated at the option of the
Landlord by 15 days' notice after the date of the award of condemnation. The Tenant
waives any right to any portion of the award received by the Landlord as damages for the
taking of the property.
32. VACATING PREMISES: Tenant agrees to vacate the premises and deliver all keys to
Landlord at the end of the Lease.
33. DELAY OF POSSESSION: If Landlord is unable to give the Tenant possession at the
beginning of the term, the rent shall be rebated on a pro rata basis until possession can be
given, which rebated rent shall be accepted by Tenant as full settlement of all damages
occasioned by said delay, and if possession cannot be delivered within ten (10) days of
the beginning of said term, this Lease may be terminated by either Landlord or Tenant by
giving prior written notice of such termination.
34. RENTER'S INSURANCE. Management is not responsible for any damage or injury
that occurs to Tenant or his/her property, guests or their property. Management
recommends that Tenant obtain Renter's Insurance to protect against injuries or property
damage.
35. THIRD PARTY ACTIONS. Management is not responsible for the actions, or for any
damages, injury or harm caused by third parties (such as other residents, guests, intruders
or trespassers) who are not under management's control.
36. NOTICES: Any notice for which provision is made in this Lease, shall be in writing and
shall be deemed given when (a) personally delivered (b) mailed by certified mail as
defined in Iowa Code §618.15, whether or not a receipt is signed for the notice, to the
place held out by Landlord or Tenant as the place for receipt of communication, or to the
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person's last known place of residence, or (c) delivery by service in the manner provided
by Iowa law for the service of original notice.
37. ATTACHMENTS TO THE LEASE AGREEMENT:
The Tenant certifies that he/she has received a copy of this Lease, and the following
Attachments to this Lease and understands that these Attachments are part of this Lease.
a. Attachment No. 1: Move-in/Move-out Apartment Inspection Report
b. Attachment No. 2: Rent Payment Policy
C. Attachment No. 3: HAP Tenancy Addendum, if applicable
d. Attachment No. 4: Section 8 Project Based Voucher Statement of Family
Responsibility, if applicable
38. SIGNATURES:
TENANT DATE
BY:
2. I I
LANDLORD
BY: EverGreen Real Estate Development Corporation
Name: Date
Title: Agent
Revised: 01/02/2025
15
Page 248 of 1264
PBV HOUSING ASSISTANCE PAYMENTS CONTRACT
[7_T:�I
EXHIBIT B
Services — Maintenance and Equipment Provided by Owner Without Charges
in Addition to Rent to Owner Includes:
1. See Standard form of Lease Agreement — Exhibit A.2.attached
2. See Service Plan Agreement — Exhibit 13.2. attached
3. See In-house Service Plan Agreement — Exhibit B.3.attached
Page 249 of 1264
EXHIBIT B.2.
SERVICE PLAN AGREEMENT
This Service Plan Agreement is made omovein_date>> between Open Arms Home
Health Care ("Service Provider"), The Rose of Dubuque ("Landlord") and
<head_name>>and «spouse—name»and ocotenant_name-1>>and «cotenant name 2> and
«cotenant_ name _3» ("Tenant"), and is incorporated into and is made a part of Tenant's
Occupancy Agreement.
1. EVALUATION/SERVICE PLAN. Prior to and as a condition of
occupancy, Landlord's designated, non-exclusive Service Provider ("Designated Service
Provider") shall evaluate each proposed Tenant's functional, cognitive and health status in
order to determine the Tenant's need for services from the Service Provider and prepare a
Service Plan. The preoccupancy Service Plan shall be developed by a healthcare
professional or human service professional in consultation with the Tenant and, at the
Tenant's request, with other individuals identified by the Tenant, and, if applicable, with
the Tenant's legal representative. All personnel who develop the plan and the Tenant or
the Tenant's legal representative must sign the plan. If the Designated Service Provider
determines that a Tenant needs personal care or health -related care, the Service Plan shall
be updated within thirty days of occupancy and thereafter as needed, but not less than
annually. The service plan shall be signed and dated by a multidisciplinary team, including
a health care professional and other staff appropriate to meet the needs of the tenant, in
consultation with the tenant and, at the tenant's request, with other individuals identified
by the tenant, and with the tenant's legal representative, if applicable. Tenant's compliance
with the Service Plan and recommended services is a condition of Tenant's occupancy at
the facility.
The Service Provider, by signing below, verifies the preoccupancy Service Plan and
certifies that Tenant does not meet Landlord's transfer requirements referenced in Lease
Section 9 and Landlord's Admission/Transfer Policy and, accordingly, is qualified for
occupancy. The verified pre -occupancy Service Plan, which details Tenant's specific
personal care or health -related care needs, is available for Tenant's review upon request_
The pre -occupancy Service Plan shall be updated by the Service Provider within thirty
days of occupancy, and as needed, but not less than annually, which updates shall be noted
on the plan updates page(s).
2. MEDICATIONS. Service Provider and Tenant have adopted a medication
plan, which details the procedures for the self -administration by Tenant of any medication
prescribed for Tenant, a copy of which is included in the pre -occupancy Service Plan. The
medication plan shall follow a medication policy in compliance with 481 IAC 67.5.
Service Provider shall be wholly responsible for administration and supervision of the
Tenant's medication plan and shall provide the necessary personnel, including a registered
nurse, to monitor, administer and implement Tenant's medication plan.
3. BASIC SERVICE PLAN. Each Tenant will be provided with basic services
by a provider of their choice, which services will be responsive to each tenant's unique
personal circumstances. The elements of the basic service plan offered by the Designated
Service Provider are detailed in The Rose In -House Service Plan Summary — Basic Service
Plan. A Tenant may contract for basic services from the Designated Service Provider or
from a third -party service provider of their choice, but a third -party service provider must
first execute an Assisted Service Program Agreement with Landlord and a Service Plan
Agreement with Tenant and Landlord. A third -party service provider may offer fewer
basic services and have a different fee or no fee for its basic services. The specifics of the
Page 250 of 1264
In -House Basic Service Plan available from Designated Service Provider are further
explained in the In -House Service Plan Summary and in The Rose Social and Recreational
Activities Policy, A No -Basic -Service Option is also available through the Designated
Service Provider, which explanation is available upon request.
4. FOOD SERVICE. Food service is available to Rose tenants, which will
provide Tenant with nutritional meals for consumption in the on -site dining room. After
Tenant elects their meal choice, a food service plan will be prepared by Landlord's
designated food service provider, which will comply with applicable assisted living facility
food service regulations and incorporate the Tenant Rules and Regulations applicable to
Food Service, and will be attached as Attachment A.
5. PERSONAL EMERGENCY RESPONSE SYSTEM. If a Personal
Emergency Response System (PERS) is included in the Resident's Preoccupancy Service
Plan, the Tenant must enter into a PERS subscription agreement with a PERS provider of
their choice and Landlord, which subscription agreement must comply with the Iowa state
regulations and Landlord policies and procedures. The pendant shall automatically identify
the Tenant in distress and shall be monitored 24 hours a day, 7 days a week. Further
explanation of a Tenant's PERS options are contained in the 24-Hour Personal Emergency
Response System Policy. The Landlord offers a PERS System, which provides 24-hour,
on -site monitoring of the Tenant's PERS by the Service Provider.
6. TRANSPORTATION. Transportation guidance will be provided regarding
third -party providers as part of the Basic Service Plan.
7. SOCIAL AND RECREATIONAL ACTIVITIES. Basic Social and
Recreational Activities will be offered to each Tenant through the Basic Service Plan.
These activities will reflect each Tenant's individual circumstances and service plan. The
Social and Recreational Activities Policy provides further explanation of the activities and
recreational programming available at The Rose.
8. STAFFING. Service Provider and Landlord shall provide sufficient trained
staff onsite at the Assisted Living Facility to fully meet Tenant's needs identified in the
Service Plan, medication plan, and the Basic Service Plan and this Service Plan Agreement
and to accommodate the optional services elected by the Tenant.
9. FEES.
Service Plan Services - per Service Provider Home Care Service
Agreement attached hereto as Attachment B;
Medication Plan - per Service Provider Horne Care Service Agreement
attached hereto as Attachment B;
Basic Service Plan — per Service Provider Home Care Service Agreement
attached hereto as Attachment B;
Food Service - per Food Service plan attached hereto as Attachment A;
PERS — per PERS Agreement attached hereto as Attachment C.
While it is the Tenant's responsibility to pay the fees referenced above, that
payment obligation may be satisfied through third party payments arranged in advance with
the respective payee or provider.
N
Page 251 of 1264
10. PAYMENT. Failure to pay for services referenced in this Agreement or
otherwise arrange for payment shall result in discontinuance of the respective services and
termination of this Service Plan Agreement.
11. BILLING PROCEDURE. Tenant shall receive a monthly billing for
elected services, which shall be payable as designated in the respective billing statement.
12. TERMINATION OF AGREEMENT. This Service Plan Agreement shall
terminate upon the occurrence of one of the following:
(i) Termination of Tenant's lease at the Rose;
(ii) Termination of the Assisted Service Program Agreement between
Service Provider and Landlord and transition of Tenant's care to and
acceptance of service for Tenant's Service Plan by another
authorized service provider, which has entered into an Assisted
Service Program Agreement with Landlord;
(iii) Authorized transfer of Tenant's care to and acceptance of service for
Tenant's Service Plan by another authorized service provider, which
has entered into an Assisted Service Program Agreement with
Landlord;
(iv) Tenant's failure to cooperate with the Service Plan and Tenant's
obstruction of the administration and implementation of the Service
Plan by the Service Provider;
(v) Tenant's failure to pay for services provided to Tenant pursuant to
this Service Plan Agreement and the Tenant's Service Plan.
TENANT:
Date:
SERVICE PROVIDER:
OPEN ARMS HOME HEALTH CARE
AGENCY
By:_
Its:
Date:
TENANT'S REPRESENTATIVE
Date:
LANDLORD:
THE ROSE OF DUBUQUE, L.P.
By:_
Its:_
Date:
ATTACHMENTS (if applicable):
A. Food Service Plan Subscription Agreement
B. Home Care Service Agreement
C. PERS Agreement
Revised: September 2025
Page 252 of 1264
EXHIBIT B.3.
In -House Service Plan Summary
All residents may select a service provider of their choice. However, any service provider must first be
qualified and provide the resident with certain required basic services. To be qualified, a service
provider must agree to enter into a Service Agreement with The Rose, which commits the service
provider to providing cares consistent with regulatory requirements of serving clients in a licensed ALF.
The in-house service provider offers a basic service package, which includes the required basic services.
This Basic Service plan offered by the in-house service provider costs $935. If you select a different
service provider, it may offer fewer basic services and have a different fee or no fee for its basic services.
There is also a no -basic -service option available through the in-house provider, which explanation is
available upon request.
In addition to the basic services, your chosen service provider will provide other services in response to
the service needs identified in your individualized needs assessment. If you have chosen the in-house
service provider, this summary explains the basic and other services, which will be provided to you. A
more detailed explanation of those services is contained in your Service Plan Agreement.
Service Provider's Basic Service Plan includes:
• The cost of Activities and Special Events. We give attention to each resident's personal
circumstances and provide a social, family -like atmosphere.
• On -Site staff to provide a secondary level of pendant response readiness greater than just
primary pendent monitoring alone; the cost of any particular secondary response is not included
in the Basic Service Plan, and instead, will be billed separately
• Mandatory Assessment completed within 30 days after admission and upon significant changes
in condition, return from hospitalization, and annual assessments
• 24/7 staffing for additional security at night and on weekends
• Daily activity — door flag checks;
• Facilitation and coordination of Disaster Plans, Emergency Preparedness and Evacuations (i.e.,
Fire Drills and response to Fire Alarms)
• Five Free General Care Calls per month; a PERS activation and PERS acknowledgment will not
constitute a care call; however, any service beyond acknowledgment and reset of the pendant
will be deemed a general or medical care call as the circumstances warrant; PERS are intended
only for emergency situations; a non -emergency PERS call is not a "free" care call and will be
billed to the resident.
• Community Resource/Medicaid Liaison Services
o Providing guidance to resident regarding access to third -party providers, such as
medical services, transportation and on -site congregate meal services
o Referral for social services and financial support resources
• Prevention and Wellness Clinics/General Health and General Nutritional Oversight
Additional Ala Carte Services — Fee Per Service: See Published Rates (to be attached by in-house
service provider) for specific service fees
• Homemaker Services (light housekeeping, laundry) may be paid by Elderly Waiver; otherwise as
Fee Per Service.
• General Care Calls are unscheduled, non -medical visits for such services as meal delivery, mail
pick-up, adjust blinds, grocery unloading, and other general assistance. Care calls are billed in
Page 253 of 1264
fifteen minute units. Care calls are not to be generated with a PERS activation. PERS activations
may be used for any purpose, but are limited to emergency -only situations. Non -emergency PERS
activations will be charged as a billable care call and will not be credited as a free care call. General
care calls in excess of the five free care calls are billed to each resident and are not eligible for
Elderly Waiver or Medicaid coverage.
• Medical Care Calls are unscheduled events for such medical services as distress checks, blood
pressure checks, incontinence accidents, vomiting and secondary pendant responses of a medical
nature; medical care calls may be paid by Medicaid; otherwise as a Fee Per Visit.
• Nursing Visits may be paid by Medicaid; otherwise as Fee Per Visit.
• Home Health Aide maybe paid by Medicaid; otherwise as Fee Per Visit.
Basic Service Plan Fee - $935 per month
Payment options:
1. Payable from insurance/LT care coverages or other third -party payors, e.g., elderly waiver.
The Basic Service Plan includes on -call features. $910 of the Basic Service fee is attributable to on -call
features and readiness and may be covered in large part by the Elderly Waiver as an On -Call Service
through the Rose's participation in the Assisted Living Facility Assisted Living Service Program. When a
third -party payor (e.g., elderly waiver) is available, the cost to the resident shall be $25.
Note: if the monthly payment authorization from third party payors, e.g., elderly waiver, is less than 31
daily service units , the resident will have a co -pay obligation of $350 ($25 for basic services and $325 for
on -call features). The $325 portion of the resident's co -pay obligation may be avoided if the third -party
payor (e.g., elderly waiver) payment authorization equals 31 daily units.
2. Absent third -party payors, residents may pay a fee based on ability -to -pay, but in no event less
than $350.
Ability -to -pay Formula: Fee = 30% of resident's Net Income
Net Income = Gross qualified income less tenant's out-of-pocket payments for rent, meals, PERS
and Open Arms services and an $400 personal allowance.
The resident's ability -to -pay fee is calculated to be , which is more/less (circle one)
than $350.
Election:
elect to subscribe to the Basic Service Plan Fee. The Basic Service Fee is payable and remains the
resident's obligation for as long as the resident's lease is in effect, regardless of whether the resident is
absent from the building.
• My third -party payor is
• 1 agree that if payment from my third party payer authorization is less than 31 daily units
per month, I will have a co -pay obligation of $350, rather than $25.
• 1 do not have a third party payor and my ability -to -pay formula fee is
Client Signature:
Date:
Updated 07/17/2024
Page 254 of 1264
PBV HOUSING ASSISTANCE PAYMENTS CONTRACT
PART 1
EXHIBIT C
Utilities Provided by Owner Without Charges in Addition to
Rent to Owner Includes:
• Landlord pays all utilities (including Internet), except cable and
telephone - Exhibit A.2. attached (standard form of Lease
Agreement).
Page 255 of 1264
Apartment Inspection Report
The Rose of «community»
Resident's Name —((head name)) «spouse name» Apartment No ((apt nbr»
Move -In Date «movein date)) Move -Out Date
AREA / ITEM
MOVE IN
MOVE OUT
CHARGES
Living Room
Blinds
Carpet & Flooring
Fixtures
Windows / Screens
Walls
Other
Kitchen/Dining Room
Cabinets
Counter Tops
Dishwasher
Walls
Garbage Disposal
Fixtures — lights, faucets, knobs
Entry Door
Lock
Stove/Vent Hood
Refrigerator
Sinks
Floor
Other
Bedroom One
Blinds
Doors
Windows / Screens
Walls
Closet
Carpet/Flooring
Bedroom Two
Blinds
Doors
Windows / Screens
Walls
Closet
Carpet/Flooring
Other
Page 256 of 1264
Bathroom
Cabinets
Toilet
Fixtures
Doors
Flooring
Sink
Shower/Shower Seat
Walls
Linen Closet
Wardrobe Closet
Other
Storage Closet
Air Conditioner / Remote
Smoke Alarms
PERS / Pendent
# of Unit Keys
# of Fobs
# of Mailbox Keys
# of Building Keys
Total Charges
I and/or we accept this form as part of the Lease Agreement and agree that it is an accurate account of
the condition of said premises, and any damage of said premises, unless I report otherwise in writing
within 48 hours of move in. The signature of one resident/appointee shall constitute acceptance by all
parties.
I certify that the foregoing report accurately represents the condition of the above -identified apartment
and that the apartment is in decent, safe, and sanitary condition. If the report discloses any deficiencies,
I certify that they will be remedied within 30 days of the date this resident moves in to the apartment.
Resident Move -In Signature
Resident Move -Out Signature
Forwarding Address
March 23, 2015 Update
Management Move -In Signature
Management Move -Out Signature
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PBV HOUSING ASSISTANCE PAYMENTS CONTRACT
PART 1
EXHIBIT D
Features Provided to Comply with Program Features of Section 504
of the Rehabilitation Act of 1973
• 100 % of the units are adaptable
• 5% are fully accessible
• The unit showers are equipped with low dam heights and added grab
bars for ease of use
• The unit cabinets in all units have ADA compliant toe kick space.
• All stools have grab bars installed.
• The flooring types are chosen so as to not inhibit wheelchair or walker
use.
• All doors in the entire facility are 3/0 and meet accessibility
requirements
• All door hardware meets ADA compliance.
• All outlets are installed higher than standard to meet ADA reach limits.
• There are two elevators to accommodate HDCP access to upper floors.
• There are (2) whirlpool bathing rooms to assist residents who have
extraordinary issues bathing themselves.
• The exterior patios and walkways are designed to provide opportunity
for residents to enjoy exterior features
• There are raised planted beds in addition to the garden plots.
Page 258 of 1264
Tenancy Addendum U.S. Department of Housing OMB Approval No. 2577-0169
Section 8 Project -Based and Urban Development (exp. 04/30/2026)
Voucher Program Office of Public and Indian Housing
(to be attached to the lease)
OMB Burden Statement. Public reporting burden for this collection of information is estimated to average 0.25 hours, including the time for
collecting, reviewing and reporting the data. The information is being collected as required by 24 CFR 983.256(b)(3), under which the lease between
the owner and the tenant must include a HUD -required tenancy addendum. Assurances of confidentiality are not provided under this collection. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to the
Office of Public and Indian Housing, US. Department of Housing and Urban Development, Washington, DC 20410. HUD may not conduct and
sponsor, and a person is not required to respond to, a collection of information unless the collection displays a valid control number.
Privacy Notice: The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form by 24
CFR 983.256(b)(3). The information is used to provide Section 8 PBV assistance in the form of housing assistance payments. The Personally
Identifiable Information (PII) data collected on this form are not stored or retrieved within a system of record.
Instructions for use of Tenancy Addendum:
This tenancy addendum is used in the Section 8 project -based voucher (PBV) program. Under the program, HUD
provides funds to a public housing agency (PHA) for rent subsidy on behalf of eligible families. The main regulation for
this program is 24 Code of Federal Regulations Part 983.
The tenancy addendum has two parts:
Part A: Tenancy Addendum Information (fill-ins). See section by section instructions.
Part B: Tenancy addendum (no information is entered in this part).
How to fill in Part A - Section by Section Instructions:
Section 2: Tenant
Enter full name of tenant.
Section 3. Contract Unit
Enter address of unit, including apartment number, if any.
Section 4. Household Members
Enter full names of all PHA -approved household members. Specify if any such person is a live-in aide, which is a person
approved by the PHA to reside in the unit to provide supportive services for a family member who is a person with
disabilities.
Section 5. Initial Lease Term
Enter first date and last date of initial lease term. The initial lease term must be for at least one year. 24 CFR § 983.256(f).
Section 6. Initial Rent to Owner
Enter the amount of the monthly rent to owner during the initial lease term.
Section 7. Initial Tenant Rent
Enter the initial monthly amount of tenant rent.
Section 8. Housing Assistance Payment
Enter the initial amount of the monthly housing assistance payment.
Section 9. Utilities and Appliances
The lease must specify what utilities and appliances are to be supplied by the owner, and what utilities and appliances are
to be supplied by the tenant. Fill in section 9 to show who is responsible to provide or pay for utilities and appliances.
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Part A of the Tenancy Addendum
(Fill out all of the information in Part A.)
1. Contents of Tenancy Addendum
This Tenancy Addendum has two parts:
Part A: Tenancy Addendum Information
Part B: Tenancy Addendum
2. Tenant
3. Contract Unit
4. Household
The following persons may reside in the unit. Other persons may not be added to the household without prior
written approval of the owner and the PHA.
5. Initial Lease Term
The initial lease term begins on (mm/dd/yyyy):
The initial lease term ends on (mm/dd/yyyy):
6. Initial Rent to Owner
The initial rent to owner is: $
7. Initial Tenant Rent
The initial tenant rent is: $ per month. The amount of the tenant rent is subject to
change by the PHA during the term of the lease in accordance with HUD requirements.
8. Initial Housing Assistance Payment
At the beginning of the Housing Assistance Payments (HAP) contract term, the amount of the housing assistance
payment by the PHA to the owner is $ per month. The amount of the monthly housing
assistance payment by the PHA to the owner is subject to change during the HAP contract term in accordance
with HUD requirements.
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Utilities and Appliances
The owner shall provide or pay for the utilities and appliances indicated below by an "O". The tenant shall
provide or pay for the utilities and appliances indicated below by a "T". Unless otherwise specified below, the
owner shall pay for all utilities and appliances provided by the owner.
Item
Specify fuel type
Paid by
Heating
[—]Natural gas
❑ Bottle gas ❑Oil or Electric
❑ Coal or Other
Cooking
UNatural gas
❑ Bottle gas ❑Oil or Electric
❑ Coal or Other
Water Heating
❑Natural gas
❑Bottle gas ❑Oil or Electric
❑ Coal or Other
Other Electric
I
Water
Sewer
Trash Collection
Air Conditioning
Provided by
Refrigerator
Range/Microwave
Other (specify)
I/We, the undersigned, certify under penalty of perjury that the information provided above is true and correct. WARNING: Anyone
who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for
up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012; 31 U.S.C. §3729, 3802).
Signatures:
Owner
Print or Type Name of Owner
Signature
Print or Type Name and Title of Signatory
Date
Previous editions are obsolete
Tenant
Print or Type Name of Family Representative
Signature
Print or Type Name of Family Representative
Date
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Part B of the Tenancy Addendum
1. Section 8 Project -Based Voucher (PBV) Program
a. The owner is leasing the contract unit to the tenant for occupancy by the tenant's family with assistance for a tenancy
under the Section 8 PBV program of the United States Department of Housing and Urban Development (HUD).
b. The owner has entered into a Housing Assistance Payments Contract (HAP contract) with the public housing agency
(PHA) under the PBV program. Under the HAP contract, the PHA will make housing assistance payments to the owner
to assist the tenant in leasing the unit from the owner.
2. Lease
a. The owner has given the PHA a copy of the lease, including any revisions agreed to by the owner and the tenant.
The owner certifies that the terms of the lease are in accordance with HUD requirements and the lease includes the
tenancy addendum.
b. The tenant shall have the right to enforce the tenancy addendum against the owner. If there is any conflict between
the tenancy addendum and any other provisions of the lease, the language of the tenancy addendum shall control.
3. Use of Contract Unit
a. During the lease term, the family will reside in the contract unit with assistance under the PBV program.
b. The composition of the household must be approved by the PHA. The family must promptly inform the PHA of the
birth, adoption or court -awarded custody of a child. Other persons may not be added to the household without prior
written approval of the owner and the PHA.
c. The contract unit may be used for residence only by the PHA -approved household members. The unit must be the
family's only residence. Members of the household may engage in legal profit -making activities incidental to primary
use of the unit for residence by members of the family.
d. The tenant may not sublease or let the unit.
e. The tenant may not assign the lease or transfer the unit.
4. Rent to Owner
a. The initial and redetermined rent to owner are established in accordance with HUD requirements.
b. During the term of the lease (including the initial term of the lease and any extension term), the rent to owner may
at no time exceed:
(1) The reasonable rent for the unit as most recently determined or redetermined by the PHA in accordance with
HUD requirements, or
(2) Rent charged by the owner for comparable unassisted units in the premises.
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5. Family Payment to Owner
a. The tenant rent is the portion of the monthly rent to owner paid by the family. The PHA determines the tenant rent
in accordance with HUD requirements. Any changes in the amount of the tenant rent will be effective on the date stated
in a notice by the PHA to the family and the owner.
b. Each month, the PHA will make a housing assistance payment to the owner on behalf of the family in accordance
with the HAP contract. The amount of the monthly housing assistance payment will be determined by the PHA in
accordance with HUD requirements for a tenancy under the Section 8 PBV program.
c. The monthly housing assistance payment shall be credited against the monthly rent to owner for the contract unit.
d. The tenant is not responsible for paying the portion of rent to owner covered by the PHA housing assistance payment
under the HAP contract between the owner and the PHA. A PHA failure to pay the housing assistance payment to the
owner is not a violation of the lease. The owner may not terminate the tenancy for nonpayment of the PHA housing
assistance payment.
e. The owner may not charge or accept, from the family or from any other source, any payment for rent of the unit in
addition to the rent to owner. The rent to owner includes all housing services, maintenance, utilities and appliances to
be provided and paid by the owner in accordance with the lease. The rent to owner does not include charges for non -
housing services such as food, furniture or supportive services provided by the owner.
f. The owner must immediately return any excess rent payment to the tenant.
6. Other Fees and Charges
a. With the exception of families receiving PBV assistance in assisted living developments (see paragraph b. below),
the owner may not require the tenant or family members to pay charges for any meals or supportive services which
may be provided by the owner. Nonpayment of any such charges is not grounds for termination of tenancy.
b. In assisted living developments receiving project -based assistance, the owner may charge tenants, family members,
or both for meals or supportive services. Any such charges must be specified in the lease. These charges may not be
included in the rent to owner, nor may the value of meals and supportive services be included in the calculation of the
reasonable rent. Non-payment of such charges is grounds for termination of the lease by the owner in assisted living
developments.
c. The owner may not charge the tenant extra amounts for items customarily included in rent to owner in the locality,
or provided at no additional cost to unsubsidized tenants in the premises.
7. Maintenance, Utilities, and Other Services
a. Maintenance
(1) The owner must maintain the unit and premises in accordance with the HQS.
(2) Maintenance and replacement (including redecoration) must be in accordance with the standard practice for the
building concerned as established by the owner.
b. Utilities and Appliances
(1) The owner must provide all utilities needed to comply with the HQS.
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(2) The owner is not responsible for a breach of the HQS caused by the tenant's failure to:
(a) Pay for any utilities that are to be paid by the tenant.
(b) Provide and maintain any appliances that are to be provided by the tenant.
c. Family Damage. The owner is not responsible for a breach of the HQS because of damages beyond normal wear
and tear caused by any member of the household or by a guest.
d. Housing Services. The owner must provide all housing services as agreed to in the lease.
8. Termination of Tenancy by Owner
a. Requirements. The owner may terminate the tenancy only in accordance with the lease and HUD requirements.
b. Grounds. During the term of the lease (the initial term of the lease or any extension term), the owner may terminate
the tenancy only because of:
(1) Serious or repeated violation of the lease;
(2) Violation of Federal, State, or local law that imposes obligations on the tenant in connection with the
occupancy or use of the unit and the premises;
(3) Criminal activity or alcohol abuse (as provided in paragraph c); or
(4) Other good cause (as provided in paragraph d).
c. Criminal Activity or Alcohol Abuse
(1) The owner may terminate the tenancy during the term of the lease if any member of the household, a guest
or another person under a resident's control commits any of the following types of criminal activity:
(a) Any criminal activity that threatens the health or safety of, or the right to peaceful enjoyment of the
premises by, other residents (including property management staff residing on the premises);
(b) Any criminal activity that threatens the health or safety of, or the right to peaceful enjoyment of their
residences by, persons residing in the immediate vicinity of the premises;
(c) Any violent criminal activity on or near the premises; or
(d) Any drug -related criminal activity on or near the premises.
(2) The owner may terminate the tenancy during the term of the lease if any member of the household is:
(a) Fleeing to avoid prosecution, or custody or confinement after conviction, for a crime, or attempt to
commit a crime, that is a felony under the laws of the place from which the individual flees, or that, in
the case of the State of New Jersey, is a high misdemeanor; or
(b) Violating a condition of probation or parole under Federal or State law.
(3) The owner may terminate the tenancy for criminal activity by a household member in accordance with this
section if the owner determines that the household member has committed the criminal activity, regardless of
whether the household member has been arrested or convicted for such activity.
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(4) The owner may terminate the tenancy during the term of the lease if any member of the household has
engaged in abuse of alcohol that threatens the health, safety or right to peaceful enjoyment of the premises by other
residents.
d. Other Good Cause for Termination of Tenancy
(1) During the initial lease term, other good cause for termination of tenancy must be something the family did
or failed to do.
(2) During the initial lease term or during any extension term, other good cause includes:
(a) Disturbance of neighbors,
(b) Destruction of property, or
(c) Living or housekeeping habits that cause damage to the unit or premises.
(3) After the initial lease term, such good cause includes the tenant's failure to accept the owner's offer of a new
lease or revision.
e. Automatic Renewal of the Lease
Although the lease automatically renews (for successive definite terms or for an indefinite extension of the term, as
provided for in the lease), an owner may terminate the lease for good cause.
f. Protections for Victims of Domestic Violence, Dating Violence, Sexual Assault, or Stalking.
(1) Purpose: This section incorporates the protections for victims of domestic violence, dating violence,
sexual assault, or stalking in accordance with subtitle N of the Violence Against Women Act of 1994, as amended
(codified as amended at 42 U.S.C. 14043e et seq.) (VAWA) and implementing regulations at 24 CFR part 5,
subpart L.
(2) Conflict with other Provisions: In the event of any conflict between this provision and any other
provisions included in Part C of the HAP contract, this provision shall prevail.
(3) Effect on Other Protections: Nothing in this section shall be construed to supersede any provision of
any Federal, State, or local law that provides greater protection than this section for victims of domestic
violence, dating violence, sexual assault or stalking.
(4) Definition: As used in this section, the terms "actual and imminent threat," "affiliated individual,"
"bifurcate," "dating violence," "domestic violence," "sexual assault," and "stalking" are defined in HUD's
regulations at 24 CFR part 5, subpart L. The terms "Household" and "Other Person Under the Tenant's Control"
are defined at 24 CFR part 5, subpart A.
(5) VAWA Notice and Certification Form: The PHA shall provide the tenant with the "Notice of Occupancy
Rights under VAWA" and the certification form described under 24 CFR 5.2005(a)(1) and (2).
(6) Protection for victims of Domestic Violence, Dating Violence, Sexual Assault, or Stalking:
(a) The landlord or the PHA will not deny admission to, deny assistance under, terminate from participation
in, or evict the tenant on the basis of or as a direct result of the fact that the tenant is or has been a victim of
domestic violence, dating violence, sexual assault, or stalking, if the tenant otherwise qualifies for admission,
assistance, participation, or occupancy. 24 CFR 5.2005(b)(1).
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(b) The tenant shall not be denied tenancy or occupancy rights solely on the basis of criminal activity
engaged in by a member of the tenant's household or any guest or other person under the tenant's control, if
the criminal activity is directly related to domestic violence, dating violence, sexual assault, or stalking, and
the tenant or an affiliated individual of the tenant is the victim or the threatened victim of domestic violence,
dating violence, sexual assault, or stalking. 24 CFR 5.2005(b)(2).
(c) An incident or incidents of actual or threatened domestic violence, dating violence, sexual assault, or
stalking will not be construed as serious or repeated violations of the lease by the victim or threatened victim
of the incident. Nor shall such incident or incidents be construed as other "good cause" for termination of the
lease, tenancy, or occupancy rights of such a victim or threatened victim. 24 CFR 5.2005(c)(1) and (c)(2).
(7) Compliance with Court Orders: Nothing in this Addendum will limit the authority of the landlord, when
notified by a court order, to comply with the court order with respect to the rights of access or control of property
(including civil protection orders issued to protect a victim of domestic violence, dating violence, sexual assault,
or stalking) or with respect to the distribution or possession of property among members of the tenant's
household. 24 CFR 5.2005(d)(1).
(8) Violations Not Premised on Domestic Violence, Dating Violence, Sexual Assault, or Stalking: Nothing
in this section shall be construed to limit any otherwise available authority of the landlord to evict or the public
housing authority to terminate the assistance of a tenant for any violation not premised on an act of domestic
violence, dating violence, sexual assault, or stalking that is in question against the tenant or an affiliated
individual of the tenant. However, the landlord or the PHA will not subject the tenant, who is or has been a victim
of domestic violence, dating violence, sexual assault, or stalking, to a more demanding standard than other tenants
in determining whether to evict or terminate assistance. 24 CFR 5.2005(d)(2).
(9) Actual and Imminent Threats:
(a) Nothing in this section will be construed to limit the authority of the landlord to evict the tenant if the
landlord can demonstrate that an "actual and imminent threat" to other tenants or those employed at or
providing service to the property would be present if the tenant or lawful occupant is not evicted. In this
context, words, gestures, actions, or other indicators will be construed as an actual and imminent threat if
they meet the following standards for an actual and imminent threat: "Actual and imminent threat" refers to a
physical danger that is real, would occur within an immediate time frame, and could result in death or serious
bodily harm. In determining whether an individual would pose an actual and imminent threat, the factors to
be considered include: the duration of the risk, the nature and severity of the potential harm, the likelihood
that the potential harm will occur, and the length of time before the potential harm would occur. 24 CFR
5.2005(d)(3).
(b) If an actual and imminent threat is demonstrated, eviction should be used only when there are no other
actions that could be taken to reduce or eliminate the threat, including, but not limited to, transferring the
victim to a different unit, barring the perpetrator from the property, contacting law enforcement to increase
police presence, developing other plans to keep the property safe, or seeking other legal remedies to prevent
the perpetrator from acting on a threat. Restrictions predicated on public safety cannot be based on
stereotypes, but must be tailored to particularized concerns about individual residents. 24 CFR 5.2005(d)(4).
(10) Emergency Transfer: A tenant who is a victim of domestic violence, dating violence, sexual assault, or
stalking may request an emergency transfer in accordance with the PHA's emergency transfer plan. 24 CFR
5.2005(e). The PHA's emergency transfer plan, which must be made available upon request, must:
(a) Incorporate strict confidentiality measures to ensure that the PHA does not disclose a tenant's dwelling
unit location to a person who committed or threatened to commit an act of domestic violence, dating
violence, sexual assault, or stalking against the tenant;
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(b) Give the victim priority to receive the next available opportunity for continued tenant -based rental
assistance if they have been living in the PBV unit for one year or more. 24 CFR 983.261;
(c) Describe policies or efforts a PHA will take when the victim has been living in a unit for less than one
year, or the victim seeks to move sooner than a tenant -based voucher will be available.
(d) For transfers in which the tenant would not be considered a new applicant, the PHA must ensure that a
request for an emergency transfer receives, at a minimum, any applicable additional priority that is already
provided to other types of emergency transfer requests. For transfers in which the tenant would be considered
a new applicant, the plan must include policies for assisting a tenant with this transfer.
(11) Bifurcation: Subject to any lease termination requirements or procedures prescribed by Federal, State, or
local law, if any member of the tenant's household engages in criminal activity directly relating to domestic
violence, dating violence, sexual assault, or stalking, the landlord may "bifurcate" the lease, or remove that
household member from the lease, without regard to whether that household member is a signatory to the lease, in
order to evict, remove, or terminate the occupancy rights of that household member without evicting, removing,
or otherwise penalizing the victim of the criminal activity who is also a tenant or lawful occupant. Such eviction,
removal, termination of occupancy rights, or termination of assistance shall be effected in accordance with the
procedures prescribed by Federal, State, and local law for the termination of leases or assistance under the Housing
Choice Voucher program. 24 CFR 5.2009(a). If the Landlord bifurcates the Lease to evict, remove, or terminate
assistance to a household member, and that household member is the sole tenant eligible to receive assistance, the
landlord shall provide any remaining tenants or residents a period of 30 calendar days from the date of bifurcation
of the lease to:
(a) Establish eligibility for the same covered housing program under which the evicted or terminated tenant
was the recipient of assistance at the time of bifurcation of the lease;
(b) Establish eligibility under another covered housing program; or;
(c) Find alternative housing.
(12) Family Break-up: If the family break-up results from an occurrence of domestic violence, dating violence,
sexual assault, or stalking, the PHA may offer the victim the opportunity for continued tenant -based rental
assistance.
(13) Move with Continued Assistance: The public housing agency may not terminate assistance to a family or
member of the family that moves out of a unit in violation of the lease, with or without prior notification to the
public housing agency, if:
(a) The move was needed to protect the health or safety of the family or family member who is or has been
a victim of domestic violence, dating violence, sexual assault, or stalking; and
(b) The family or member of the family reasonably believes that he or she was threatened with imminent
harm from further violence if he or she remained in the dwelling unit. However, any family member that
has been the victim of a sexual assault that occurred on the premises during the 90-calendar day period
preceding the family's move or request to move is not required to believe that he or she was threatened with
imminent harm from further violence if he or she remained in the dwelling unit. 24 CFR 983.261.
(15) Confidentiality:
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(a) The Landlord shall maintain in strict confidence any information the Tenant (or someone acting on
behalf of the Tenant) submits to the Landlord concerning incidents of domestic violence, dating violence,
sexual assault or stalking, including the fact that the tenant is a victim of domestic violence, dating violence,
sexual assault, or stalking.
(b) The Landlord shall not allow any individual administering assistance on its behalf, or any persons within its
employ, to have access to confidential information unless explicitly authorized by the Landlord for reasons that
specifically call for these individuals to have access to the information pursuant to applicable Federal, State, or
local law.
(c) The Landlord shall not enter confidential information into any shared database or disclose such
information to any other entity or individual, except to the extent that the disclosure is requested or consented
to in writing by the individual in a time -limited release; required for use in an eviction proceeding; or is
required by applicable law.
g. Eviction by Court Action. The owner may evict the tenant only by a court action.
h. Owner Notice of Grounds
(1) At or before the beginning of a court action to evict the tenant, the owner must give the tenant a notice that
specifies the grounds for termination of tenancy. The notice may be included in or combined with
any owner eviction notice.
(2) The owner must give the PHA a copy of any owner eviction notice at the same time the owner notifies the
tenant.
(3) Eviction notice means a notice to vacate, or a complaint or other initial pleading used to begin an eviction
action under State or local law.
9. PHA Termination of Assistance
The PHA may terminate program assistance for the family for any grounds authorized in accordance with HUD
requirements. If the PHA terminates program assistance for the family, the lease terminates automatically.
10. Lease: Relation to HAP Contract
If the HAP contract terminates for any reason, the lease terminates automatically.
Upon termination or expiration of the HAP contract without extension, each family assisted under the contract may
elect to use its assistance to remain in the same project if the family's unit complies with the inspection requirements,
the rent for the unit is reasonable, and the family pays its required share of the rent and the amount, if any, by which
the unit rent (including the amount for tenant -based utilities) exceeds the applicable payment standard.
11. Family Right to Move
a. The family may terminate its lease at any time after the first year of occupancy. The family must give the owner
advance written notice of intent to vacate (with a copy to the PHA) in accordance with the lease. If the family has
elected to terminate the lease in this manner, the PHA must offer the family the opportunity for tenant -based
rental assistance in accordance with HUD requirements.
b. Before providing notice to terminate the lease under paragraph a, the family must first contact the PHA to request
tenant -based rental assistance if the family wishes to move with continued assistance. If tenant -based rental
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assistance is not immediately available upon lease termination, the PHA shall give the family priority to receive
the next available opportunity for tenant -based rental assistance.
12. Security Deposit
a. The owner may collect a security deposit from the tenant. (However, the PHA may prohibit the owner from
collecting a security deposit in excess of private market practice, or in excess of amounts charged by the owner to
unassisted tenants.)
b. When the family moves out of the contract unit, the owner, subject to State and local law, may use the security
deposit, including any interest on the deposit, as reimbursement for any unpaid rent payable by the tenant, any damages
to the unit or any other amounts that the tenant owes under the lease.
c. The owner must give the tenant a list of all items charged against the security deposit, and the amount of each item.
After deducting the amount, if any, used to reimburse the owner, the owner must promptly refund the full amount of
the unused balance to the tenant.
d. If the security deposit is not sufficient to cover amounts the tenant owes under the lease, the owner may collect the
balance from the tenant.
13. Prohibition of Discrimination
In accordance with applicable nondiscrimination and equal opportunity laws, statutes, Executive Orders, and
regulations, the owner must not discriminate against any person because of race, color, religion, sex (including sexual
orientation and gender identity), national origin, age, familial status, or disability in connection with the lease.
Eligibility for HUD's programs must be made without regard to actual or perceived sexual orientation, gender
identity, or marital status.
14. Conflict with Other Provisions of Lease
a. The terms of the tenancy addendum are prescribed by HUD in accordance with Federal law and regulation, as a
condition for Federal assistance to the tenant and tenant's family under the Section 8 PBV program.
b. In case of any conflict between the provisions of the tenancy addendum as required by HUD, and any other
provisions of the lease or any other agreement between the owner and the tenant, the requirements of the HUD -required
tenancy addendum shall control.
15. Changes in Lease and Rent
a. The tenant and the owner may not make any change in the tenancy addendum. However, if the tenant and the owner
agree to any other changes in the lease, such changes must be in writing, and the owner must immediately give the
PHA a copy of such changes. The lease, including any changes, must be in accordance with the requirements of the
tenancy addendum.
b. The owner must notify the PHA in advance of any proposed change in lease requirements governing the allocation
of tenant and owner responsibilities for utilities. Such changes may be made only if approved by the PHA and if in
accordance with the terms of the lease relating to its amendment. The PHA must redetermine reasonable rent in
accordance with HUD requirements, based on any changes in the allocation of responsibility for utilities between the
owner and tenant, and the redetermined reasonable rent shall be used in the calculation of the rent to owner from the
effective date of the change.
16. Written Notices
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Any notice under the lease by the tenant to the owner or by the owner to the tenant must be in writing.
17. Definitions
Contract unit. The housing unit rented by the tenant with assistance under the program.
Excepted Unit. A contract unit in a multifamily building not counted against the per -building cap on PBV assistance
(25 units or 25 percent of the units in the project, whichever is greater) (see 24 CFR § 983.56(b)).
Family. The persons who may reside in the unit with assistance under the program.
HAP contract. The housing assistance payments contract between the PHA and the owner. The PHA pays housing
assistance payments to the owner in accordance with the HAP contract.
Household. The persons who may reside in the contract unit. The household consists of the family and any PHA -
approved live-in aide. (A live-in aide is a person who resides in the unit to provide necessary supportive services for a
member of the family who is a person with disabilities.)
Housing quality standards (HQS). The HUD minimum quality standards for housing assisted under the Section 8
PBV program.
HUD. The U.S. Department of Housing and Urban Development.
HUD requirements. HUD requirements for the Section 8 PBV program. HUD requirements are issued by HUD
headquarters as regulations, Federal Register notices or other binding program directives. The Lease Addendum shall
be interpreted and implemented in accordance with HUD requirements.
Lease. The written agreement between the owner and the tenant for the lease of the contract unit to the tenant. The
lease includes the tenancy addendum prescribed by HUD.
PHA. Public Housing Agency.
Premises. The building or complex in which the contract unit is located, including common areas and grounds.
Program. The Section 8 project -based voucher program.
Rent to owner. The total monthly rent payable to the owner for the contract unit. The rent to owner is the sum of the
portion of rent payable by the tenant plus the PHA housing assistance payment to the owner.
Section 8. Section 8 of the United States Housing Act of 1937 (42 United States Code 1437f).
Tenant. The family member (or members) who leases the unit from the owner.
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U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
Section 8 Project -Based Voucher Program
Statement of Family Responsibility
OMB Approval No. 2577-0169
Exp. (04/30/2026)
OMB Burden Statement: The public reporting burden for this collection of information is estimated
to average 0.25 hours, including the time for collecting, reviewing and reporting the data. The informat
ion is being collected as required by 24 CFR 983.252(b), under which the PHA must give the family a
packet that includes the family obligations under the program. Assurances of confidentiality are not
provided under this collection. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions to reduce this burden, to the Office of Public and
Indian Housing, US. Department of Housing and Urban Development, Washington, DC 20410. HUD
may not conduct and sponsor, and a person is not required to respond to, a collection of information
unless the collection displays a valid control number.
Privacy Notice: The Department of Housing and Urban Development (HUD) is authorized to collect
the information required on this form by Section 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f).
The information is used to certify the members of the family participating in the Section 8 project -
based voucher program and the family's awareness of their family responsibilities under the program.
The Personally Identifiable Information (PII) data collected on this form are not stored or retrieved
within a system of record.
1. Certification. The undersigned public housing agency (PHA) hereby certifies that
the family consisting of the following members:
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is eligible to participate in the Section 8 project -based voucher program of this
PHA and is approved to occupy a unit at:
Under this program, the PHA makes housing assistance payments to owners for
units leased and occupied by participating families.
2. Tenant Rent. The tenant rent is the portion of the monthly rent to owner paid by
the family, and is based on the family's income, composition, and expenses. The
PHA determines the tenant rent in accordance with HUD requirements.
3. Changes in Tenant Rent. A family's tenant rent may change because of changes
in program requirements or changes in family income, composition, or expenses.
Any change in a family's tenant rent will be effective on the date stated in a notice
by the PHA to the family and owner.
4. PHA Housing Assistance Payment. The monthly housing assistance payment by
the PHA to the owner for a unit leased by a family is the rent to owner minus the
tenant rent (total tenant payment minus any applicable utility allowance). The
family is not responsible for payment of the portion of the rent to owner covered
by the housing assistance payment.
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5. Family Right to Move.
(A) The family may terminate its lease at any time after the first year of
occupancy. The family must give the owner advance written notice of
intent to vacate (with a copy to the PHA) in accordance with the lease. If
the family elects to terminate the lease in this manner, the PHA must offer
the family the opportunity for continued tenant -based rental assistance in
accordance with HUD requirements.
(B) Before providing notice to terminate the lease under paragraph (A), the
family must first contact the PHA to request tenant -based rental assistance
if the family wishes to move with continued assistance. If tenant -based
rental assistance is not immediately available upon lease termination, the
PHA must give the family priority to receive the next available
opportunity for continued tenant -based rental assistance.
6. Family Obligations.
(A) Any family participating in the project -based voucher program of the
undersigned PHA must follow the rules listed below in order to continue
to receive housing assistance under the program. Any information the
family supplies must be true and complete.
(B) Each family member must:
Supply any information that the PHA or HUD determines to be
necessary for administration of the program.
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2. Supply any information requested by the PHA or HUD for use in a
regularly scheduled reexamination or interim reexamination of
family income and composition.
3. Disclose and verify social security numbers and sign and submit
consent forms for obtaining information.
4. Supply any information requested by the PHA to verify that the
family is living in the unit or information related to family absence
from the unit.
5. Promptly notify the PHA in writing when the family is away from
the unit for an extended period of time in accordance with PHA
policies.
6. Allow the PHA to inspect the unit at reasonable times and after
reasonable notice.
7. Notify the PHA and the owner in writing before moving out of the
unit or terminating the lease.
8. Use the assisted unit for residence by eligible family members. The
unit must be the family's only residence.
9. Promptly notify the PHA in writing of the birth, adoption, or court -
awarded custody of a child.
10. Request PHA written approval to add any other family member as
an occupant of the unit.
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11. Promptly notify the PHA in writing if any family member no
longer lives in the unit.
12. Give the PHA a copy of any owner eviction notice.
13. Pay utility bills and provide and maintain any appliances that the
owner is not required to provide under the lease.
14. Submit evidence of citizenship or eligible immigration status if
they are seeking assistance. Families in which all members are
U.S. citizens or have eligible immigration status are eligible for
assistance. Mixed families, in which at least one member is a U.S.
citizen or has eligible immigration status and at least one member
does not contend eligible immigration status, are eligible for pro-
rated assistance.
(C) The family (including each family member) must not:
1. Own or have any interest in the unit.
2. Commit any serious or repeated violation of the lease.
3. Commit fraud, bribery or any other corrupt or criminal act in
connection with the program.
4. Engage in drug -related criminal activity or violent criminal activity
or other criminal activity that threatens the health, safety or right to
peaceful enjoyment of other residents and persons residing in the
immediate vicinity of the premises.
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5. Sublease or let the unit or assign the lease or transfer the unit.
6. Receive project -based voucher assistance while receiving another
housing subsidy for the same unit or a different unit under any
other Federal, State or local housing assistance program.
7. Damage the unit or premises (other than damage from ordinary
wear and tear) or permit any guest to damage the unit or premises.
8. Receive project -based voucher assistance while residing in a unit
owned by a parent, child, grandparent, grandchild, sister or brother
of any member of the family, unless the PHA has determined (and
has notified the owner and the family of such determination) that
approving rental of the unit, notwithstanding such relationship,
would provide reasonable accommodation for a family member
who is a person with disabilities.
9. Engage in abuse of alcohol in a way that threatens the health,
safety or right of peaceful enjoyment of the other residents and
persons residing in the immediate vicinity of the premises.
7. Termination of Assistance. The PHA may terminate housing assistance for any
grounds authorized in accordance with HUD requirements, including family
violation of any obligation under Section 6 of this Statement of Family
Responsibility.
8. Illegal Discrimination. If the family has reason to believe that it has been
discriminated against on the basis of age, race, color, religion, sex
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(including sexual orientation and gender identity), disability, national
origin, or familial status, the family may file a housing discrimination
complaint with any HUD office in person, by mail, or by telephone. The PHA
will give the family information on how to fill out and file a complaint.
Eligibility for HUD's programs must be made available without regard to actual
or perceived sexual orientation, gender identity, or marital status.
9. Violence Against Women Act (VAWA). VAWA and HUD's implementing
regulations provide housing protections for victims of domestic violence, dating
violence, sexual assault, and stalking. The PHA will provide the Notice of
Occupancy Rights and Certification Form and is responsible for having an
emergency transfer plan. The lease addendum also includes a description of
specific protections.
10. HUD Requirements. HUD requirements for the Section 8 project -based voucher
program are issued by Headquarters as regulations, Federal Register notices, or
other binding directives. The Statement of Family Responsibility shall be
interpreted and implemented in accordance with HUD requirements.
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KEEP THIS DOCUMENT FOR YOUR RECORDS
Family
Name of Family Representative:
Address, Telephone Number:
Signature of Family Representative, Date:
Public Housing Agency
Name of PHA:
Address, Telephone Number:
Signature of PHA Representative, Title, Date:
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