Instructions
All for-profit organizations must complete this form. Government agencies, tribal governments, tribal government agencies, and nonprofit organizations are not required to complete this form.

Nonprofit organizations must complete Organization Capacity and Review form for Nonprofit organizations.

This form should be completed by the Applicant’s chief financial officer or executive director. 

Name of Person Completing Form:       		
Position:	     
Date:  		     
Email:  		         			
Phone:  	     

A.	Applicant Information
1.	Does your organization have written policies and procedures for the following business processes? Check one box for each area.
Accounting:     Yes	 No	 Not Sure            
Purchasing:      Yes	 No	 Not Sure             
Payroll:             Yes		 No	 Not Sure            

If the organization applied for Manufactured Home Community Redevelopment Program Request For Proposal (RFP) funds in 2022 or 2023 and has not changed its written policies/procedures for Accounting, Purchasing, and Payroll, certify that nothing has changed on its policies. 

No change to policies and procedures:   ________________________________________________
Finance Manager or Executive Director signature

B.	Legal Issues
1.	Are there any current or pending lawsuits against the organization?  
a.	 Yes    No  

b.	If yes, describe any impact on the organization’s financial position.
     

2.	Are there any current or pending lawsuits against the organization’s executive director or chief financial officer?  
a.	 Yes    No  

b.	If yes, provide details.
     

3.	Has the organization lost any funding due to compliance issues, misuse, or fraud in the last five years?  
a.	 Yes    No  

b.	If yes, describe the situation, including when it occurred.
     

C.	Required Documents (must attach)
Organizational, Management and Operations	
	1.	Operating Agreement	
	2.	Authorizing Resolutions	
	3.	Organization Certificate of Good Standing (current through at least 2022, via Minnesota’s Secretary of State Business and Lien System)	
	4.	Strategic Plan or Work/Business Plan 	
Financial	
	5.	For organizations with gross revenue ≥ $750,000:  The last two years of audited financial statements, including any Management Letter and Internal Controls Letter.	
	6.	For organizations with gross revenue < $750,000: Federal and State Tax returns including K1s filed with the IRS (for the last two years) 	

D.	Insurance Certification
If funded, the organization will provide certificates of liability naming Minnesota Housing as loss payee in coverage amounts prior to contract execution. Insurance should cover, at minimum, as follows:

1.	Commercial General Liability  
a.	Minimums for Contracts:
i.	$2M per occurrence
ii.	$2M annual aggregate
iii.	$2M annual aggregate – Products/Completed Operations
b.	Coverage must include: Premises and Operations Bodily Injury and Property Damage; Personal and Advertising Injury; Blanket Contractual Liability; Products and Completed Operations Liability
c.	State of Minnesota named as an additional insured, to the extent permitted by law
d.	Applies to operations under contract whether by the contractor or subcontractor or anyone directly or indirectly employed by the Contractor under the contract

2.	Worker’s Compensation. Minimums for Contracts:
a.	$100K – Bodily Injury by Disease per employee
b.	$500K – Bodily Injury by Disease aggregate
c.	$100K – Bodily Injury by Accident

I certify that if awarded funds, prior to contract execution,       will provide insurance coverage with Minnesota Housing as loss payee in the amounts listed above.

For Administrators receiving new construction or acquisition, rehabilitation, resale awards, including interim loans for construction financing, provide in the Administrator file prior to construction initiation:

3.	Property Insurance for each developed property at coverage amounts equaling the full replacement value, and (if applicable) an endorsement or rider providing coverage for rehabilitation work in an amount equal to or at least the amount of Impact Fund dollars to be used in the Project.

I certify that if awarded funds, prior to construction initiation,       will provide property insurance coverage for each unit in the amount listed above.

	     
Authorized Signature					Date
						
	     
Printed Name 						Position