Certification

I attest that the information included in and with this application is correct and complete.

I attest that I have not applied for or received rental assistance from other sources for the months for which I am requesting KERA assistance. If I receive assistance from other sources for the same month(s), I will return the KERA funds to KHRC.

I agree to waive all late fees owed by the tenant for the months for which I receive KERA funds.

I agree not to evict the tenant or report to credit agencies for non-payment of rent for the months for which KERA funds are received.

I agree to fully cooperate with KHRC on any reasonable requests and compliance inquiries relating to this application.

I shall maintain all records pertaining to this application for a minimum of five years and shall provide access to such records as may be requested.

I attest that, in processing this application, I have complied with all applicable fair housing laws, including but not limited to, Fair Housing Law which makes it illegal to discriminate in residential housing on the basis of race, color, religion, national origin, sex, familial status, source of funds, sexual orientation, gender identity, status as a veteran, or disability.

I attest that I have been given the opportunity to review KHRC’s Privacy Policy, Terms of Use and Disclaimer and I agree to the terms and conditions contained in each of those documents.

I authorize KHRC, providers of utilities and telecommunications services including internet, and any entity that provides assistance or housing stability services (including but not limited to: federal, state, tribal, municipality, charitable organization and nonprofits) to share and verify information provided by me or others in support of my KERA application, including but not limited to personally identifiable information, and benefits awarded or denied to me, previously and prospectively.

If applicable, I authorize the City of Wichita to provide KHRC with confidential benefit data including but not limited to first and last name, address, phone number, e-mail address, social security number of the head of household and amount due, paid, fees and assistance awarded for each month and year for each of the following programs: Wichita Emergency Rental Assistance Program, Emergency Assistance Program, Section 8 Housing Choice Voucher Program or ESG funded Homeless Prevention Programs.

I understand that submission of an application does not guarantee that I am eligible for benefits or assistance and that other factors may be considered in reviewing my application. Further, I understand that KERA funds will not be disbursed until it has been determined that the tenant and I am eligible to participate and all proper certifications and required documents have been submitted to KHRC.

I attest that I have not been disqualified for State or Federal funding due to fraud.

I understand I may be subject to civil and criminal penalties if I knowingly provide false or misleading information related to this application. I further understand that it is a criminal violation under Kansas law to make a false statement in writing for the purpose of procuring assistance from a state agency.

I understand and agree that I may be required to repay KERA funds to KHRC if I am later found to be ineligible or provide false, misleading or incomplete information.

If this application is completed by an authorized agent on behalf of Landlord, authorized agent attests that it is authorized to act on behalf of Landlord as its agent with respect to this application and attests and agrees to all certifications in this application by submitting this application.

I attest that I have been given the opportunity to review KHRC’s Privacy Policy, Terms of Use and Disclaimer and I agree to the terms and conditions contained in each of those documents.

I understand this is a LEGALLY BINDING DOCUMENT.

Limitation of Liability and Indemnification. By using this Site, you agree to DEFEND, INDEMNIFY, RELEASE AND HOLD HARMLESS THE STATE OF KANSAS, KHRC, ITS OFFICERS, DIRECTORS, EMPLOYEES, CONTRACTORS AND AGENTS (THE “RELEASED PARTIES”) FROM ANY AND ALL CLAIMS, ACTIONS, SUITS AND DEMANDS THAT RELATE TO OR ARISE OUT OF: (1) YOUR KERA APPLICATION; (2) ANY ACTION OR INACTION TAKEN BY THE RELEASED PARTIES IN THE ADMINISTRATION AND MANAGEMENT OF KERA; (3) USE OR INABILITY TO USE THIS SITE OR INFORMATION AVAILABLE FROM THIS SITE; (4) LOSS OF DATA OR COMPUTER EQUIPMENT RESULTING FROM THE SITE OR THE DOWNLOAD OF ANY INFORMATION OR CONTENT FROM THIS SITE; (5) TRANSACTIONS OR CONTACT BETWEEN YOU AND THIRD PARTIES LINKED TO THIS SITE; (6) FOR ANY VIOLATION BY YOU OF THE TERMS OF USE AGREEMENT OR PRIVACY POLICY; AND (7) CLAIMS, ACTIONS, SUITS AND DEMANDS BROUGHT BY OTHER PERSONS OR ENTITIES ARISING FROM OR RELATED TO YOUR USE OF THIS SITE OR INFORMATION OBTAINED FROM THIS SITE. IN NO EVENT SHALL THE RELEASED PARTIES BE LIABLE OR RESPONSIBLE FOR ANY LOSS, DIRECT, INDIRECT, PUNITIVE, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGE (INCLUDING BUT NOT LIMITED TO LOSS OF BUSINESS, REVENUE, PROFITS, USE, DATA OR OTHER ECONOMIC ADVANTAGE), ATTORNEYS’ FEES, EXPENSES OR COSTS IN THE EVENT OF SUCH CLAIMS, ACTIONS, SUITS AND DEMANDS.