step 1 – submit your application -...

Application Form - Peterborough Renovates Program, 2019Step by Step Application PackageReturn completed application with supporting documentation before 4:00 p.m. on Friday May 24, 2019.

By Mail/In-Person: Habitat for Humanity Peterborough and Kawartha Region300 Milroy Drive, Peterborough, ON K9H 7M9

By Email: [email protected] or By Fax: 705-755-0621

Read the Program Guidelines before filling in this application.

Incomplete applications will not be processed.

Eligible applicants will be considered for funding based on a priority basis considering both income and the type of repair/modification, subject to available funding.

Do not start your project until you receive a Funding Letter and an executed legal agreement. You could be determined ineligible if your work has already begun or has been completed.

Step 1 – Submit your application1. Read the “Am I Eligible to Apply for Funding” section of the Program Guidelines.

2. Complete this Application and attach all required documents. Attachments can be photocopies or digital photos of the documents.

The shaded boxes at the end of the sections indicate what needs to be included in order for the Application to be considered complete. Habitat for Humanity can give you any additional forms that you may need.

3. Bring in or email your complete Application to Habitat for Humanity. Staff will check for completeness and let you know what needs added/updated if incomplete. Please plan ahead of the deadline to make sure there is enough time to make changes before the due date of May 24, 2019. Your application must be signed and include project quotes.

4. Your complete Application will be reviewed by Habitat for Humanity and then the City of Peterborough’s Housing Services staff.

Step 2 – Selection of successful projects1. If your project is selected to be funded, you will receive a Funding Letter and a loan

agreement by mid-July. The letter will include instructions from the City on next steps. If you are not successful, you will receive a letter explaining the decision.

2. The letter list details for moving forward and securing the loan. You will work with the staff at Habitat for Humanity to complete these next steps.

3. When the work is complete contact Habitat for Humanity for a site review. You can then begin the payment request process (See the Program Guidelines pages 12 and 13). Funds for the contractors’ invoice(s) are issued to you or your lawyer, depending on the Program Loan amount.

Questions? Contact Habitat for Humanity at 705-750-1456. of 17 - Step By Step Application Package (Version April 15, 2019)

mailto:[email protected]

Application Form - Peterborough Renovates Program, 2019Section 1 – Applicant Information (Include all members of the household)

Applicant: Main contact for this Application.

Full Name:

Email:

Phone Number:

Co-Applicant: Spouse, partner or other registered owner.

Full Name:

Home/Project Address:

Do all owners reside at this address? : Yes or No(If no, complete a Non-Resident Owner Form and attach)

Status in Canada (Applicant) Canadian Citizen Landed Immigrant Refugee Refugee Claimant

Total number of people living in your home:

List any couples living in your home:Name Date of Birth

List any Dependents in the home: (under 18 years or over 18 years and in school full-time)Full Name Date of Birth Relationship to Applicant

Attach for Section 1: Copy of two pieces of identification for all adults (e.g. Driver’s License, Passport, Birth Certificate, Other government issued ID (Not Health Card) – one must have a photo

Authorization and Direction of Non-Resident Owner Form (optional depending on ownership) – Ask Habitat for form if applicable


Application Form - Peterborough Renovates Program, 2019Section 2 – Property InformationDoes any member of the household have full/partial ownership of another property?

Yes No

Have you received previous government funding for home repairs at this address?Yes No

If Yes, provide the Project Reference number: and the date approved: and describe what the repairs that received funding were:

Your home is:Semi-Detached Detached Town/Row house Other (specify):

Your home is years old.

The assessed property value is $ (attach MPAC letter)

Are your Property Tax payments up to date? (attach tax receipt or bank statement)Yes No

Is your home insurance payment up to date? (attach insurance receipt/bank statement)Yes No

Are your Mortgage Payments up to date? (attach proof of both)Yes No or No Mortgage

Your current Mortgage Value is ($): or N/A

Is any other credit secured against the home/property?Yes No If Yes, attach credit statement

Are there any outstanding Orders, Liens or Claims currently against the property?Yes No If Yes, please explain:

Attach for Section 2: Current Municipal Property Assessment Corporation (MPAC) property assessment letter showing your house value

Property Tax payments up to date (tax receipt or bank statements) Proof of insurance payments up to date (insurance receipt or bank statement) Proof of current mortgage value and other credit, with payments up to date (if there is a mortgage or line of credit)

Verification of the status of any other Secured Credit against home/property – Ask Habitat for form if applicable

Section 3 – Project Owner InformationHousehold type: (select one) Single or Family or Congregate


Application Form - Peterborough Renovates Program, 2019Provincial Program Funding Target: (select if applicable)

Aboriginal / Indigenous peoples Person(s) with disabilities Senior(s)Victims of Domestic Violence Recent Immigrant

How do I determine my total gross household income?Total household income is the current year’s gross income (before taxes and other deductions) of all people living in the dwelling including the homeowner; the spouse or partner; children / dependents; and, any other persons who live in the same dwelling, aged 16 years and over. Please complete the Income Worksheet, below:

Source of Income HomeownerHomeowner/Spouse/Partner

Children/Dependent

Other HouseholdMembers

Yearly gross earnings

CPP, OAS, GIS, private pensions, annuities, supplements, Veterans’ Allowance, disability pensions, etc.

EI income ODSP, Ontario Works, Family Benefits, Worker’s Compensation etc.

Bank interest, investment and dividend income

Alimony or child support income

Other income: please specify

Total income from all sources

(A)

(B)

(C)

D)

Total gross household income (A+B+C+D) = $

Less Federal Disability Tax Credit (if applicable) $

Adjusted gross household income $

Attach for Section 3: 2018 Notice of Assessment(s) for all household members with income (T4s and other year-end statements may be accepted)

Section 4 – Type of Work RequiredCheck all that apply:

Accessibility features Electrical


Application Form - Peterborough Renovates Program, 2019 Fire Safety Foundation / Structural Heating Overcrowded Plumbing Roof Replacement Septic/Well Water/Well Drilling Ventilation Windows & Doors Other (List what the repair is)

Attach photos and describe the repair(s) needed, based on contractor quotes.

Describe the reason for the repair below. You can add pages if you need more space.

Attach for Section 4: Photographs of your project needs (existing conditions) Contractor Selection Form(s) Written quotes from all Contractors (2 minimum)


Application Form - Peterborough Renovates Program, 2019

Section 5 – Project Costs, Contributions and Summary of Funds RequestedDesign Costs: (e.g. architect, engineer, Appraisal Fees, 3rd Party Opinion Costs, etc.)

$ Contractor Costs:

$ (costs based on selected Contractor quote)Project Soft Costs: (include A, B, and C1 or C2 listed below)

$70.00 Initial title Search - Grants and Loans (City Legal Division) – required

$215.00 Project Completion Review (Habitat for Humanity) – required

$900.00 Legal Fees (Applicant’s Solicitor/Lawyer) – loans over $8,000OR $80.00 Security/Notice on Title Fees (City Legal Division) - loans under $7,999 Total Project Soft Costs:

$ Total Construction Costs:

$ Contributions

Homeowner Contribution:$

Energy Rebate Programs:$

Other: (Please specify: )$

Total Contribution from Others: $ $

Summary of Funds Requested:Total Peterborough Renovates Project Cost:(Total Construction Costs minus Total Contribution from Others)

$ Grant Amount: (Based on Accessibility Form) - Ask Habitat for Humanity, if applicable

$ Forgiveable Loan Amount: (to be completed by Habitat for Humanity)

$

Attach for Section 5: Accessibility Form (if applicable) – ask Habitat for Humanity



Section 6 – Development Schedule Milestones

When can the repair begin?

How long will it take to complete the project?

Section 7 – Solicitor Information

If your project is expected to cost over $8,000, please complete below:Lawyer’s Name:

Lawyer’s Contact Information:

Section 8 – Applicant Checklist:Details on criteria are included in the Program Guidelines, available online at www.habitatpeterborough.ca. Please attach the following supporting documentation to your Application. Habitat for Humanity staff will provide all of the required forms for you to complete, as outlined below. Check the boxes to indicate the supporting documents and verification are attached.Attach for Section 1:

Copy of two pieces of identification for all adults (e.g. Driver’s License, Passport, Birth Certificate, Other government issued ID (Not Health Card) – one must have a photo

Authorization and Direction of Non-Resident Owner Form (optional depending on ownership) – Ask Habitat for form if applicableAttach for Section 2:

Current Municipal Property Assessment Corporation (MPAC) property assessment letter showing your house value

Property Tax payments up to date (tax receipt or bank statements) Proof of insurance payments up to date (insurance receipt or bank statement) Proof of current mortgage value and other credit, with payments up to date (if there is a

mortgage or line of credit) Verification of the status of any other Secured Credit against home/property – Ask

Habitat for form if applicableAttach for Section 3:

2018 Notice of Assessment(s) for all household members with income (T4s and other year-end statements may be accepted)Attach for Section 4:

Photographs of your project needs (existing conditions) Contractor Selection Form(s) Written quotes from all Contractors (2 minimum)

Attach for Section 5: Accessibility Form (if applicable) – ask Habitat for Humanity

Questions? Contact Habitat for Humanity at 705-750-1456. of 17 - Step By Step Application Package (Version April 15/19)

http://www.habitatpeterborough.ca/


Promissory Note Declaration Form

I/We hereby confirm that I/we am/are the owners of the house and property located at the project address identified on the Application, and that no other person is an owner.

Address:

(the "Premises")

Peterborough Renovates Funding Amount: $ (the “Funding”)

This Promissory Note is made by me/us in accordance with the terms of the accepted

application dated for the Premises.

If I/we sell the Premises without the prior written consent of the City of Peterborough or if I/we

breach any terms of my/our receipt of the Funding, then I/we promise to repay the City of

Peterborough the whole of the Funding less an amount equal to any loan forgiveness.

I/we further acknowledge that this Promissory Note is an interim document used to establish

my/our obligation to repay the Funding less an amount equal to any loan forgiveness. I/We

understand and agree that the City of Peterborough will, at a later date, require appropriate

security, such as a mortgage/charge and/or the registration of a Notice on title. I/We also agree

to execute an agreement concerning my/our receipt of the Funding and my/our obligations

concerning the Funding.

Applicant Name: Signature: ____________________Date:

Applicant Name: Signature: ____________________Date:

Witness Name: Signature: ____________________Date:

Signed by all, each in the presence of the other.


Application Form - Peterborough Renovates Program, 2019Assignment of Payment Form

Applicant’s Name:

IAH Reference No.:

I/we hereby authorize The City of Peterborough, to directly pay:

1. The Delivery Agent, for the Project Completion Review site visit and associated

reporting, to confirm completion of the Work, in accordance with the application and

supporting documents. The cost of this service is $215.00; and

2. For Searches and Sub-Searches of the applicant and their property, as part of the

screening process. This will involve legal searches for liens, outstanding Orders and any

peculiarities on Title such as deceased owners. The cost of this task is:

a. For applications of Accessibility Grants $70.00; or

b. For applications of Forgivable Loans $ 70.00

3. Legal Services for Registration of Notice on Title, for projects valued between $0 and

$7,999.99. The cost of this task is $80.00; OR

The cost of these efforts has been included in the grant / loan amount, and shall be deducted

from the final payment to the applicant or their legal representative, as applicable, from the City

of Peterborough at the completion of the project.

Also included in the loan amount, on loans that exceed $7,999.99 will be a stipulated fee of

$900.00 for legal services to compensate the Applicant’s lawyer for their services as identified

on the Legal Representation Required Form of the Application Package.

Signature: Date:

(Applicant)

Signature: Date:

(Witness)


Application Form - Peterborough Renovates Program, 2019Indemnity / Liability Waiver FormIn consideration of the monies received from the Administrator (as defined below) the

Applicant(s) hereby acknowledge and agree that:

1. None of Her Majesty the Queen in the Right of the Province of Ontario, the Corporation of the City of Peterborough, the Corporation of the County of Peterborough, their employees, elected officials, officers directors and agents (collectively, the “Administrator”) have any responsibility for the Applicant’s(s’) selection and/or approval of contractor(s), trades-people materials, and construction processes;

2. The Administrator had no role in selection of contractors, trades-people, materials, or construction processes;

3. In the event that any contractor, trades-person, material, or construction process is later found to be substandard or unacceptable, the Applicant waives, as against the Administrator, any and all possible claims and demands for payment for any losses, damages, injury and/or death;

4. Any problems with any construction, renovation or remediation project (collectively, a “Project”) shall to be addressed by the Owner(s) with the contractor(s) and/or trades-people hired by the Applicant(s) without the assistance of the Administrator and that the Applicant(s) shall have the full responsibility to carry out any necessary repairs;

5. The Administrator shall not accept nor process a second application seeking funding for the same Project;

6. The Administrator accepts no responsibility for any modifications or betterments made to an applicant's property, that may or may not be implemented without the knowledge and/or consent from a co-owner; and

7. The Administrator has no further financial responsibility for ensuring that the Project is completed to the Applicant’s(s’) satisfaction, nor the satisfaction of any governing agency or body having technical jurisdiction over the Work.

I understand and agree to these conditions.

Signature: Date: (Applicant)

Witness: Date: (Witness or Co-Applicant)


Application Form - Peterborough Renovates Program, 2019Declaration and Consent (pages 1 of 2)I/We the undersigned:

a) Confirm that I/we are the owners of the home and property located at (project address) and that all owners have been identified herein. We further declare that this address is our Sole and Principle residence.

b) Grant permission to Habitat for Humanity Peterborough & Kawartha Region and The City of Peterborough to make any necessary inquiries to verify: my/our income, assets, liabilities and credit information, and/or any other pertinent details outlined in this funding application package.

c) Acknowledge that if my/our funding application is accepted it will not apply to work completed prior to receiving an executed Letter of Agreement. The only exception to this will be third party opinion costs to validate or verify project requirements.

d) Acknowledge that if my/our funding application is accepted I/we cannot claim the repairs for any Provincial tax rebate programs.

e) Declare and certify that the information provided in this Application is true and correct to the best of my/our knowledge.

f) Acknowledge that in the event that a false declaration is knowingly made, The City of Peterborough, as Service Manager, shall have the right to cancel the approval and recover any paid funds; and/or declare the mortgage (funding agreement) in default and take appropriate action as identified in the Program Guidelines.

g) Acknowledge that personal information submitted on and with this Application, is collected by Habitat for Humanity Peterborough & Kawartha Region to be used only to: contact the applicant(s) about the Program; determine eligibility; and to make application through The City of Peterborough to the Ministry of Municipal Affairs and Housing under this Program.

h) Understand that the purpose of this Application is to allow The City of Peterborough to determine eligibility for the Peterborough Renovates Program. All decisions by City staff are final. Approval for the Program Loan may only be determined after a Funding letter has been issued and a Program Loan Agreement has been executed.

i) Have read the 2019 Peterborough Renovates Program Guidelines and Step by Step Application Package and understand the program rules and eligibility requirements.

j) Understand that this Application and all schedules and attachments are subject to the Municipal Freedom of Information and Protection of Privacy Act (referred to as “MFIPPA”). Any information collected by The City of Peterborough pursuant to this Application is subject to the rights and safeguards provided for in MFIPPA.

k) Consent to the release of information to an authorized representative of The City of Peterborough for the purpose of determining initial and ongoing eligibility for the Peterborough Renovates Program.


Application Form - Peterborough Renovates Program, 2019Declaration and Consent (page 2 of 2)

l) Without restricting the generality of the consent in the above paragraph, specifically consent to the release of information relating to any assets held in any financial institutions by or on behalf of any members of the household.

m) Further consent to an authorized representative of The City of Peterborough disclosing personal information about any members of the household included for the purpose of determining initial and ongoing eligibility for the Peterborough Renovates Program.

n) Understand this consent will apply to inquiries and disclosures of personal information made relating to my/our initial and ongoing eligibility for the Peterborough Renovates Program.

o) Understand that the inquiries may take the form of electronic data exchanges.

p) Understand that this Application and related documentation shall be retained for one year from the date of submission, unless you request otherwise, unless the Application is approved for funding, in which case it shall be retained for the full forgiveness period from the date of acceptance. All personal documentation shall be destroyed by The City of Peterborough after these time periods or sooner if the information is not required.

q) Understand that personal information obtained through this Application Process will be disclosed only if/when necessary to the following: employees of Habitat for Humanity; The City of Peterborough; the Province of Ontario and any other governing authority as required by law.

r) Consent to the verification, disclosure and transfer of information given on this Application, and subsequently any additional Applications and documents of this Program, by or to any of the above named entities.

s) Hereby release The City of Peterborough, Housing Services and any employee, officer, agent or contractor from any liability or claim arising from the collection, storage, use of dissemination of any information received or collected pursuant to this Declaration and Consent of the Step By Step Application Package for the Peterborough Renovates Program.

Signed this day of , 2019.Signature of Applicant: Applicant Name:

_________________________________ Signature of Co-Applicant: Co-Applicant Name:

_________________________________



Key Dates: As of April 15, 2019 - Peterborough Renovates Program applications will be accepted. May 24, 2019 - Peterborough Renovates Program applications will not be accepted after

this date. Program Loans are available while funding is available.

For successful applicants: The Program Loan requires Annual Program Compliance.

Annual Program Compliance:For 10 years, as outlined in your Program Loan Agreement, you will be required to:

Submit Annual Program Compliance documentation in response to the annual letter from the City’s Housing Services (i.e. photocopy of identification and a utility bill);

Inform the City of Peterborough if you propose to refinance; Inform the City of Peterborough if there is a change in status of the applicant or

co-applicant (e.g. death, separation); and Repay the loan, as calculated by the City of Peterborough’s Housing Services, if you

propose to sell, an Event of Default, or if you no longer use the home as your sole and principal residence.



Home Conditions Form (3 pages)

It is necessary for all Applicant(s) to walk through your home and complete this Home

Conditions Form. It is an assessment you do yourself, identifying the conditions of the listed

elements of your home. This is your opportunity to identify all areas of your home that require

necessary repairs. Information you include on this form will assist in the overall ranking and

prioritization of applications for funding purposes.

Date of the assessment by the Homeowner:

Structural

Indicate the condition of the following:Satisfactory

CommentsYes No N/ABuilding ExteriorFoundation (cracks, rubble, settlement, exposed rebar)

Exterior cladding

Paint (cracking, peeling, flaking, dirty)

Masonry/ concrete (cracking, spalling, mortar deterioration, efflorescence, staining, graffiti)

Siding (dented, rotting)

Roofs

Ponding, drainage failure

Ridges, displaced ballast, pavers

Membrane splitting/ damaged

Flashing and sealants damaged

Shingle curling, loss of granules

Catwalk

Attic ventilators (roof, soffit) Eaves troughs and downspouts (plugged, damaged, not secure)



Home Conditions Form (page 2 of 3)Structural (continued)Indicate the condition of the following:

SatisfactoryCommentsYes No N/A

Doors and Windows

Frame deterioration

Warpage, drafts

Hardware condition

Threshold, sill condition

Cracked glazing

Screens torn, loose, missing

Condensation between panes

Sealants

Weather-stripping missing

Balconies, porches and guards

Deck cracking, spalling

Railings loose, rusting

Reinforcing steel corrosion

Inadequate drainage

Wood deterioration

Supports

Plumbing

Pipes and fixtures

Hot water tank

Water heater

Basement drainage

Sump Pump

Access to a source of potable water



Home Conditions Form (page 3 of 3)Heating

Indicate the condition of the following:Satisfactory

CommentsYes No N/A

Exhaust fans, timers, controls

Furnaces, fan coil units and incremental units

Water heater

Basement drainage

Sump Pump

Access to a source of potable water

Fire SafetyAre the following maintained and operating efficiently?

SatisfactoryCommentsYes No N/A

Smoke alarms

Fire extinguisher and heat detectors

Septic, Well Water, Well Drilling Indicate the condition of septic and well water:

ElectricalIs electrical system safe and to code?

OvercrowdedIs the dwelling overcrowded?

OtherAre there any other required repairs not mentioned above?



Delivery Agent Declaration to Service Manager

(Habitat for Humanity to complete this portion)

I declare that the enclosed statements and answers to the questions are true and complete to the best of my knowledge.

Print Name: (Habitat staff)Signature: ______________________

Position: Habitat for Humanity Peterborough & Kawartha Region.

Dated at this day of 2019.

Date Delivered to Service Manager: by:

Date Received by Service Manager: by:


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