FHSP: Proposal Submission

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Thank you for visiting the Project Based Site Proposal Submission form, hosted by Brilliant Corners in partnership with Los Angeles County Department of Health Services.

Before You Get Started:

Below is a list of the required documents needed to complete this form. You may also access them here . Please have all of the following materials ready before submitting. You will be prompted to upload all of the relevant files below, if applicable, and will not be able to submit the form without doing so.

Please be advised, that a Property Management Company MUST be identified prior to submitting this form.

If you have any questions during this application process, please reach out to pbvpipeline@brilliantcorners.org.

Required Documents

Project Narrative - description of the building (type, floors, units), completion date, construction/renovation timeline, and location description
Certificate of Occupancy or Temporary Certificate of Occupancy (if building construction is complete)
Photos of construction (if construction is incomplete)
PDF document of construction timeline (if construction is incomplete)
Title Report (if construction is complete)
Floor Plan with Building Schematics
Unit Matrix Spreadsheet with Unit Details (Click here for template)
Copy of Property Deed or Purchase Contract
Copy of Master Lease Agreement (if applicable)
Pro Forma - Please provide a 5-year pro forma if the building is a new construction.
Operating Budget
Experience and Capacity Form (Click here for template)

Optional Documents

Applicable Memorandum of Understanding (MOU) or Contracts

Disclaimer: Completing the form does not guarantee a contract with Brilliant Corners. The PBV Pipeline Team will review all applications with County Funders and make a final decision.

Thank you for your understanding.

DHS Funding Opportunity

Has this project been submitted for other similar funding?

Yes

What other program has this project applied to?

Has this project been awarded the funding?

Yes

What program awarded this project?

When was this project awarded?

What is the expected date of response?

Please note, DHS will not provide funding for any capital improvements, including those necessary for units to pass HQS.

Owner Information

Owner's Contact Information

Provide Owner's First and Last Name:	Provide Owner's Official Title:
Provide Owner's Phone Number:	Provide Owner's Email Address:

Business Information

Provide Owner's Business Name:

Provide Owner's Entity Type:

Example: LP, LLC, Nonprofit, etc.

Owner's Mailing Address

Owner's City:

Owner's State:

Owner's Postal/Zip Code:

Is the Owner operating with any Partners, Members and/or Principals?

Yes

Please provide their information, including business name, mailing address, and to whom correspondence should be addressed:

What is your role in this process?

I am the OwnerI am submitting on behalf of the OwnerI am the Master LesseeI am the Developer

Please confirm your email address

The email address that will be receiving email confirmation and communication.

Provide a Point of Contact

Provide First and Last Name:	Provide Title:
Provide Phone Number:	What is your relationship with the owner?

Please Provide Business Information

Provide Business Name:

Street Address:

Provide Entity Type:

Example: LP, LLC, Nonprofit, etc.

City:

State:

Postal/Zip Code:

Are you operating with any Partners, Members, and/or Principals in this Master Lease Agreement?

Yes

Please provide their information, including business name, mailing address, and to whom correspondence should be addressed.

Project Details - Part 1

Project Site Details and Amenities

Provide the Name of the Project Site: Property City:	Property Address: Property Postal/Zip Code:
What are the total number of units within this property?	How many units will be available to Brilliant Corners in this agreement?
Please provide a Project Narrative: Description of the building (type, floors, units), completion date, construction/renovation timeline, and location.	What, if any, type of amenities will be provided at this property?

Project Site Details - Part 2

Completion Stage

Is construction of the property completed?

Yes

What is the estimated completion date?

Will the project be completed within the next 6 months?

Yes

When did the site receive Certificate of Occupancy, or Temporary Certificate of Occupancy?

Please upload the Title Report

Please upload any photos of the units in their current stage

Please upload the current construction timeline

Please upload a copy of the Certificate of Occupancy or TCO

Does the project site need improvements?

Yes

What improvements need to be made to the building?

**Please note: DHS will not provide funding for any capital improvements, including those necessary for units to pass HQS**

Utilities

What utilities are paid by the Landlord/Master Lessor? To select multiple, hold ctrl on keyboard	What utilities will be paid by the client? To select multiple, hold ctrl on keyboard
If other, please specify: (Landlord)	If other, please specify: (Client)

Building Funding Sources

Funding Sources

What are the funding sources for this building?

i.e.: TCAC, LACDA, Private Equity, etc.

What are the occupancy restrictions?

To select multiple, hold ctrl on keyboard

How many units have occupancy restrictions?

What is the required age range?

Please specify type of ADA requirements/units:

Are there any occupancy restrictions for this building?

Yes

What type of senior community?

55+62+65+

Which entity is requiring the occupancy restriction?

What is the occupancy restriction?

Can you specify the other health requirements?

Are there income restrictions for this property?

Yes

What are the income restrictions for this property?

EX: 30% AMI: 40% AMI, etc.

Which entity is requiring the income restriction?

Intensive Case Management Services Provider Details

Has an Intensive Case Management Services (ICMS) entity been identified for this project?

Yes

Identified ICMS must be on this list.

Contact Information

Please provide the name of the ICMS entity that will be providing services to the property, and a point of contact.

Name of Service Provider:

ICMS Contact's Name:

ICMS Contact's Title:

ICMS Contact's Phone Number:

ICMS Contact's Email Address:

Details of ICMS Service Space

Please provide the details on the reserved space for ICMS Staff since ICMS are required to have a separate space from property management to service clients.

Where is the location of the reserved ICMS Office Space?

What is the size of the reserved ICMS Office Space in square footage?

Note: Brilliant Corners will not be furnishing ICMS office spaces.

Property Management Information

Please provide the name of the property management company and a point of contact.

Property Management Information

Provide the name of the Property Management Company:

How many years of experience does this company have in Permanent Supportive Housing?

Point of Contact Information

Property Management Contact's Name:

Property Management Contact's Title:

Property Management Phone Number:

Property Management Email Address:

Upload Documents Here

To finish this form, please upload the following documents either as a PDF or Word File. Note: some are required to complete, whereas others are conditional. Conditional documents may be required later from the PBV Pipeline Team during the lease up process if your application is accepted.

Required Documents:

Floor Plan and Building Schematics Please upload as a PDF Unit Matrix Spreadsheet Include unit numbers, size, type, AMI, sqft, accessibility	Operating Budget Pro Forma Copy of Master Lease Agreement
Copy of the Property Deed or Purchase Contract

Optional Documents

Applicable Memorandum of Understanding (MOU) or Contracts

Additional Documents 1

Additional Documents 2

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