Instructions
All nonprofit organizations must complete this form. Nonprofit organizations are those that meet the definition in Minn. Stat. 309.50 Subd. 4 or as defined by the IRS, with the most common type being a 501(c)(3). Government agencies, tribal governments, tribal government agencies, and for-profit organizations are not required to complete this form. 

For-profit organizations must complete Organization Capacity and Review form for For-Profit 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 Single Family RFP funds in 2021 or 2022 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 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
Organizations that applied for Single Family RFP funds in 2021 or 2022 do not need to submit1-4.	
	1.	Organization 501(c)(3) certification with the IRS	
	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
Organizations that applied for Single Family RFP funds in 2022 only need to submit the most recent year of board-reviewed financial statements or IRS form 990, as applicable as listed in item 5. a-c below.	
	5.	The last two years of board-reviewed financial statements or IRS forms 990, based on organization size:
a.	For organizations with ≥ $750,000 annual revenue: Audited financial statements, including any Management Letter and Internal Controls Letter
b.	For organizations with < $750,000 annual revenue:  IRS forms 990
c.	For organizations with < $50,000 annual revenue: IRS form 990  or board-reviewed financial statements	

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/rehab/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