Cal. Code Regs. tit. 4 § 7082

Current through Register 2024 Notice Reg. No. 44, November 1, 2024

Section 7082 - Content of Application Form

The following information shall accompany the Application Form:

(a) Financial Information. Applicants shall submit a copy of their 2004 final Audited Financial Statements (drafts not permitted). If an Applicant certifies that an audit was NOT completed for the year 2004, the Applicant shall submit a copy of its 2004 Federal Tax Return -- Form 990

(b) Organizational information. Applicants shall submit:

(1) a copy of their tax-exemption letter from both the Internal Revenue Service and the State Franchise Tax Board; and

(2) a copy of their most recent license or licenses (if the application references other licensed clinics), or notification of exemption from licensure, from the State Department of Health Services.

(c) Legal Information. The Applicant shall complete a legal status questionnaire.

(d) Agreement and Certification. The Applicant shall agree and certify to the following terms and conditions as a requirement of receiving any Grant. The agreement and certification shall be executed by the Executive Director or Chief Executive Officer, Chief Financial Officer, or other authorized officer of the Applicant, on behalf of the Applicant. The authorized officer of the Applicant shall agree and certify to the following terms and conditions as a requirement of receiving any Grant:

(1) The information contained in the Application Form and attachments is true and correct to the best of his or her knowledge and belief and understands that any misrepresentation may result in the cancellation of a Grant and other actions permitted by law and the Grant Agreement.

(2) The Applicant may be required to return all or a portion of the Grant if the Applicant fails to complete the Project as approved. In cases where the Grant will fund permit fees, planning fees, or land acquisition costs as part of an approved Project, the Applicant may be required to return all Grant funds if the Authority cannot determine the associated larger Project has been completed, based on the timelines provided within the Application Form.

(3) Grant funds will be used only for the Project described in the Application Form, unless a change in the Project is approved in writing by the Authority or Authority Staff pursuant to Section 7090.

(4) If a Federal Tax Return Form 990 was submitted in lieu of an Audited Financial Statement, no audit of financial statements was performed for 2004.

(5) The financial records of the Project are subject to audit and inspection by the Authority, California Department of Insurance or its designee, and/or the Commissioner.

(6) The Applicant has disclosed all information requested in the legal status questionnaire.

(7) The Applicant will notify the Authority in writing at the time of Project completion with evidence of completion included.

(8) The Applicant will provide all documents and information required by law and meets all necessary requirements prior to release of the Grant.

Cal. Code Regs. Tit. 4, § 7082

1. New section filed 11-28-2005 as an emergency; operative 11-28-2005 (Register 2005, No. 48). A Certificate of Compliance must be transmitted to OAL by 3-28-2006 or emergency language will be repealed by operation of law on the following day.
2. Amendment of subsection (d)(4) filed 12-14-2005 as an emergency; operative 12-14-2005 (Register 2005, No. 50). A Certificate of Compliance must be transmitted to OAL by 4-13-2006 or emergency language will be repealed by operation of law on the following day.
3. Repealed by operation of Government Code section 11346.1(g) (Register 2007, No. 11).
4. New section filed 3-13-2007; operative 3-13-2007 pursuant to Government Code section 11343.4 (Register 2007, No. 11).

Note: Authority cited: Sections 15437 and 15438(d), Government Code. Reference: Sections 15438(q) and 15438.6, Government Code.