Fillable CHDO Certification Application Form and Tier 1 Regulatory (Lake County)

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CHDO Certification Application Form and Tier 1 Regulatory (Lake County)

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The CHDO Certification Application Form and Tier 1 Regulatory (Lake County) form is 2 pages long and contains:

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  • 48 check-boxes
  • 11 other fields

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File type: PDF

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BROWSE LAKE COUNTY (IL) FORMS

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Lake County Consortium
Revised 8/2018 1
CHDO Certification Application Form and Tier 1 Regulatory
Thresholds Checklist
Applicant Name: __________________________________________________________________
Full Address: _____________________________________________________________________
Executive Director Name: __________________________________________________________
Contact Name (if not same as above): ________________________________________________
Phone: ___________________________ Email: _________________________________________
DUNS #: _________________________________________________________________________
CHDO Application Submission Certification
The undersigned, as an essential part of the Application for designation of Certification as a Community
Housing Development Organization (CHDO) hereby certifies that the information contained herein is
true to the best of the undersigned’s knowledge and belief. Falsification of information supplied in this
Application may disqualify the submission for CHDO Certification and/or for pending and future HOME
funds. The information given by the Applicant may be subject to verification by the Lake County
Consortium and its members, the Lake County Housing and Community Development Commission, or
Lake County Community Development serving in its capacity as administrator of the Lake County
Consortium HOME Program. Submission of this Application shall be deemed an authorization to the
Consortium to undertake such investigations as it deems necessary to determine the accuracy of this
Application and the appropriateness of certifying the applicant organization. If any information changes
after submission of this Application the undersigned agrees to notify the Consortium immediately.
The undersigned also agrees that any commitment by the Consortium to grant or loan the organization
HOME Program funding that may be forthcoming as a result of CHDO certification by means of this
Application is conditioned by the Lake County Consortium PY2019 HOME Program Guidelines, the
Housing and Community Development Commission’s policies for the HOME Program, and the Applicant’s
continued compliance with those guidelines and any HUD regulations governing the HOME Program. The
undersigned also hereby certifies that the governing body of the Applicant has formally authorized the
undersigned to execute the documents necessary to make this Application.
Representative Name (if not same as above): ________________________________________
Title: ___________________________________________________________________________
Phone: ___________________________ Email: _________________________________________
Certification Signature: ____________________________________________________________________
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Lake County Consortium
Revised 8/2018 2
Tier 1 Regulatory Thresholds Checklist
This checklist helps ensure that compliance with all regulatory thresholds is evident within this
application and attachments. The majority of requirements are fulfilled through the Charter and
Articles of Incorporation, By-laws, and Board Member Roster (attachments 1-3). Besides each of these
requirement, please check the box associated with the document that meets the requirement.
Requirements 5, 13, 15, 16, and 17 are fulfilled with attachments 4-7 and have been filled in for you.
Requirement
Charter/
Articles of
Incorp.
(Att. 1)
By-laws
(Att. 2)
Board
Member
Roster
(Att. 3)
N/A
Other
Attach-
ments
1. Organized under state or local law
2. Purpose to provide affordable housing
3.
No part of net earnings to benefit an individual
4.
Not under the control of entity seeking profit
5. Tax exempt
Att. 4
6. Not a governmental entity
7.
No more than 1/3 of board are public officials
8.
Government employees cannot be
officers/employees
9. If created by a government entity, that entity
cannot appoint more than 1/3 board
10. If organization was created by for-profit entity:
10.a. For-profit primary purpose
10.b. For-profit may not appoint more than 1/3
board
10.c. For-profit officers cannot be
officers/employees
10.d. CHDO is free to contract with others
11.
Designated service area
12.
At least 1/3 board low-income
13. Formal process for low-income input
Att. 5
14. At least 1 year serving community
Applica
tion
15. Conforms to 2 CFR 200.302-303
Att. 7
16. Active DUNS number and SAM account
Applica
tion
Form
17. Conflict of Interest Policy
Att. 6
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CHDO Certification Application Form and Tier 1 Regulatory (Lake County)

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Completed 6 August 2020

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