Ministry of Municipal Affairs and Housing Project Information Form Investment in Affordable Housing for Ontario (IAH) Extension 2014 Rental Housing Component Office Use Project Reference No. Date (yyyyy-mm-dd) 1.0 CMSM / DSSAB The District of Cochrane Social Services Administration Board 500 Algonquin Blvd. East, Timmins, ON, P4N 1B7 T 705-268-7722 F 705-268-8302 E-mail Address barberca@cdssab.on.ca marksbri@cdssab.on.ca 2.0 Contact Information Legal Name of Proponent: Contact Name Position Address No. Street Unit/Suite/P.O. Box City/Town Province Postal Code Telephone No. Fax No. Email Address 2.3 Proponent Type (Check one ) Private sector Co-operative Partnership * Municipal non-profit Municipality Private non-profit/charitable corporation *If this is a partnership, please indicate: Partner Name (Company/Organization) Partner Type (i.e., private, etc.) 2.4 Funding Has this project received AHP / IAH Funding before? Yes No 2.5 Special Feature (check what applies) Disabled Access: Full Access Unit Modifications Wheelchair Ramp
3.0 Project Information Project Name Project Location Main intersection (if municipal address has not been determined yet) Project Address No. Street Unit/Suite/P.O. Box City/Town Province Postal Code Municipal electoral location (e.g. Ward) if known 4.0 Project Type Complex Project Acquisition & Rehabilitation If Complex, specify type New Construction Conversion Major repairs or addition to a multiresidential building Affordability period as established by CMSM / DSSAB (Minimum 20 years including the phase-out period) 4.2 CMSM / DSSAB Council Approval Date (yyyy-mm-dd) Attach copy of Council Resolution if available. If not available, when is final approval anticipated? 4.3 Date RFP Issued by CMSM / DSSAB (yyyy-mm-dd)
5.0 Project Details 5.1 IAH Extension 2014 Unit Breakdown No. of Units Target Client* Unit Type Bachelor or 1, 2, 3, 4 Bedroom Household Type* Single/family Unit Size (m 2 ) Tenant Household Income Type of Repairs Required Total Funding Requested Actual Rent Total No. of Units *Target Client: Please specify target client and # of units if selected Please choose from the following groups: Aboriginal, Persons with Disabilities, Seniors, Victims of Domestic Violence, Working Poor, Other Please choose from the following type of repairs: Electrical, Fire Safety, Heating, Plumbing, Structural, Septic Systems and Well Water, Other *If exact number of rent supplement units is unknown, please provide % estimate for project:
5.2 Unit Totals No. of IAH Extension 2014 Units (must be the same as total no. of units in unit breakdown table) Non- IAH Extension 2014 Units (if applicable) Total Units (IAH Extension 2014 + Non- IAH Extension 2014 Units (if applicable)) = 5.3 If Rent Supplements are being applied, indicate funding source(s) (Check all that apply) Strong Communities Regular MOHLTC (Ministry of Health and Long-Term Care) MCSS (Ministry of Community and Social Services) 5.4 Supportive Services Source(s) for services (check all that apply) MOHLTC (Ministry of Health and Long-Term Care) MCSS (Ministry of Community and Social Services) Date of Confirmation (yyyy-mm-dd): Date of Confirmation (yyyy-mm-dd): Organization(s) that will be responsible for service provision (if known) Contact information for organizations responsible for service provision (if known) Contact Name Position E-mail Address Telephone No. (Incl. Area code and Ext.) Fax No. (incl. Area code) Contact Address No. Street Unit/Suite/P.O. Box City/Town Province Postal Code
5.5 Special Features Description Energy Efficiency Energy Star Appliances Smart Meter Other measures (specify) Disabled Access Full Access Unit Modifications Wheelchair Ramp Please provide details of repairs: Energy Efficiency Measures Please specify: 6.0 Ministerial Consents 6.1 Are you planning to build on land/property originally developed under Federal/Provincial social housing programs, subject to HSA 2011 regulations or federal operating agreements? Yes No If Yes, note a Ministerial consent is required to alter the existing mortgage and security. Please inform your provincial contact for more information. 6.2 Are you planning to build on land/property originally developed under Federal/Provincial social housing programs, currently administered by MCSS or MOHLTC (as part of a dedicated supportive housing portfolio)? Yes No If Yes please elaborate: 7.0 Land 7.1 Land Source Who currently owns the land? (Check ) Proponent Government Level: Municipal Provincial Federal Other, e.g. charitable (specify)
7.2 Access to Land Type of Access Total Area 8.0 Site Use (Check all that apply) 8.1 Current Use Vacant (former commercial/industrial) Vacant (Greenfield) Residential Agricultural Heritage site Commercial/Industrial Mixed residential/commercial 8.2 Proposed Use Infill development Mixed residential/commercial 8.3 Municipal Programs Community Improvement Plan Business Improvement Area Brownfield Community Improvement Plan Neighbourhood Revitalization Project 8.4 Site Description and Surrounding Uses Total Area of Project Property (including parking) Unit of Measurement Total Area Surrounding Uses Please describe 9.0 Mortgage Information 9.1 Name(s) of Mortgage Lender(s) Name(s) Date of Mortgage Commitment letter Date (yyyy-mm-dd) 9.2 Application for CMHC mortgage insurance date or anticipated date Anticipated Date (yyyy-mm-dd) Actual Date (yyyy-mm-dd)
10.0 Project Funding 10.1 IAH Extension 2014 Funding Soft Costs (legal, architecture, engineering, insurance taxes, fees etc. $ Construction or Hard Costs (labor, construction materials, equipment etc.) $ Total IAH Extension 2014 Funding $ 10.2 Project Contributions (Other) Proponent $ Municipal Grants / Loans $ Other $ CDSSAB DECLARATION I declare that the enclosed statements and answers to the questions are true and complete to the best of my knowledge. Signature Dated at this day of, 20. Name and position of authorized signing officer Name of Service Manager: