Citizens Energy /CITGO Petroleum Oil Heat Program

2015 EXPLANATION OF GRANT TERMS & CONDITIONS FOR BOARD MEMBERS

If Awarded A Grant, HDFC’s Agree To The Following Grant Regulations:

This grant only covers deliveries to the building, up to the grant award.

Buildings are REQUIRED to distribute money generated from this grant and to submit reports. Distribution is as follows:

67.5% of monies, divided evenly, back to the tenants of each unit Distribution of the 67.5% must be returned in the form of rental credits or arrears Distribution of the 67.5% to tenants must be made to tenants no later than 60 days from the

final payment of the grant Credits cannot be given to commercial units, vacant units, laundry rooms, community rooms, or

units occupied by a realty company, a business, or a social service organization, etc. Each unit must receive their full one-time rental credit in a single month. Rental credits cannot

be broken down into smaller amounts and given over more than one month without prior approval from Citizens Programs

32.5% to be used by the building for capital expenses for energy conservation and efficiency measures The energy conservation and efficiency measures for 32.5% must be approved by Citizens

Programs before the work is done If an outside management company has enrolled your building in the program, they are entitled to a 5%

fee and the amount distributed to tenants is 62.5% instead of 67.5%. Reports Due: Buildings must submit grant reports no later than 60 days from the receipt of the final payment of the grant:

Tenant Portion – 67.5% A rent roll or similar documentation demonstrating the use of the 67.5% distribution to tenants Rent bills for 10% of the units who received a credit showing the reduction to each of the

individual units Weatherization Portion – 32.5%

A proposal of the expected capital expenditures demonstrating the use of the 32.5% toward energy conservation and efficiency measures for the building

Contractor bids from a licensed vendor for conservation and efficiency measures for the building Receipts Due

Buildings must submit receipts by no later than October 31, 2015 Copies of invoices and cancelled checks for all weatherization work completed This report is required in order for a building to be eligible for participation in the next program year.

Audit: Buildings participating in the Citizens Energy/ CITGO Oil Heat Program understand and agree that they shall cooperate with and submit to an audit if requested by Citizens Energy/CITGO Oil Heat Program. Program Dates: Citizens Programs reserves the right to change any of the dates of the program.

Building Address / Dirección de Edificio: Apartment # / Número del Apartamento: _________________________________

Citizens Programs, working with CITGO, has expanded its Oil Heat Program to include buildings. Under this program,

buildings that qualify will be eligible to receive a grant equal to 50 gallons per unit on their oil heat during the program.

This grant will benefit all tenants of the building in the form of rental credits as well as building maintenance and repairs.

Below is an Income and Family Profile Survey we are asking you to fill out. We are collecting this information to

document that your building is providing affordable housing to low-income families. Individual family documentation is not

required, but you must indicate your total household. The results are confidential. Thank you for your cooperation.

Citizens Programs, en conjugacion con CITGO, ha ampliado su programa de aceite de calefacción para incluir edificios.

Según este programa, los edificios que cumplirán los requisitos serán elegibles para recibir una subvención equivalente a

50 galones de aceite de calefacción por cada apartamento. Esta subvención beneficiará a todos los inquilinos del edificio

en forma de créditos de alquiler, así como el mantenimiento de los edificios y las reparaciones.

Abajo tenemos una encuesta de ingresos y perfil de family que le pedimos que llena. Estamos recogiendo información

para documentar que su edificio provee viviendas asequibles a familias de bajos ingresos. No se requieren documentos

para familias individuales, pero usted debe indicar su hogar total. Los resultados son confidenciales. Gracias por su

cooperación.

Number of people in my house /número de personas en mi casa

(Please circle one/marque con un círculo)

1 2 3 4 5 6 7 8 9 10 11 12

Total household annual income/ingreso familiar annual: $ ________________

Does Anyone In The Household Receive: /Hay alguien En Su Casa familiar Recibe:

I hereby state that the above information is true and accurate / Yo certifico que la informacion en este formulario es verdadera. Signed /Firma: ________________________________________________ Date / Fecha: ______/______/20____ Print Name / Imprimir Nombre: ________________________________________________

By signing this from I attest that all information is valid and accurate on the date of signing Firmando este formulario yo certifico que toda la información es válida y exacta en la fecha de la firma

CITIZENS ENERGY /CITGO PETROLEUM

OIL HEAT PROGRAM-BUILDINGS INCOME VERIFICATION

2015 INCOME & FAMILY PROFILE SURVEY

ENCUESTA DE INGRESOS Y PERFIL DE FAMILIA

PA (public assistance/Asistencia Pubica)

Section 8 (rental assistance/Asistencia de Vivienda )

SSI (Supplemental Social Security/Sequro Social Suplementario)

SCRIE (senior citizen rental assistance/Exepcion de imcremento de renta para ancianos

OTHER/OTRO: