ERA 2.0 - SIGNED AGREEMENT MARICOPA COUNTY_COUNTERSIGNED.PDF

OMB Approved No.: 1505-0270
Expiration Date: 10/3 1/2021

U.S, DEPARTMENT OF THE TREASURY
EMERGENCY RENTAL ASSISTANCE

Eligible grantee name and address: DUNS Number: 050391270

Maricopa County Human Services Department Taxpayer Identification Number: 866000472

234 N. Central Ave., 3rd Floor Assistance Listing Number and Title: 21.023-Emergency Rental Assistance
Phoenix Arizona 85004 Program

Section 3201{a) of the American Rescue Plan Act of 2021, Pub. L. No. 117-2 (March 11, 2021), authorizes the Department of the
Treasury (“Treasury”) to make payments to certain eligible grantees to be used to provide emergency rental assistance.

The eligible grantee hereby agrees, as a condition to receiving such payment from Treasury, to the terms attached hereto.

ho

Authorized Representative Signature (above)
[To be signed by chief executive officer if recipient is a local government.]

Authorized Representative Name: Joy Rich
Authorized Representative Title: County Manager
Date Signed: 4-Jo. 202]

U.S. Department of the Treasury:

PAPERWORK REDUCTION ACT NOTICE: The information collected will be used for the U.S. Government to process requests for support, The estimated
burden associated with this coflection of information is [5 minutes per response. Comments concerning the accuracy of this burden estimate and suggestions
for reducing this burden should be directed to the Office of Privacy, Transparency and Records, Department of the Treasury, 1500 Pennsylvania Ave., N.W.,
Washington, D.C. 20220. DO NOT send the form to this address. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a valid control number assigned by OMB.

PRIVACY ACT STATEMENT

AUTHORITY: Solicitation of this information is authorized by the American Rescue Plan Act of 2021, Title IH, Pub. L. No. 117-2.

PURPOSE: Treasury is required by the American Rescue Plan Act of 2021 to identify eligible grantees/recipients to provide emergency rental assistance to
individuals who qualify for relief under the Act. Eligible grantees/recipients are state, local, and territorial governments which identify households requiring
relief according to requirements contained in the Act. Treasury maintains contact information for authorized representatives and contact persons for the
purpose of communicating with eligible grantees regarding issues related to implementation of the Act.

ROUTINE USES: The information you furnish may be shared in accordance with the routine uses outlined in the Treasury’s system of records notice, Treasury
.017 - Correspondence and Contact Information, which can be found at 81 FR 78266 (Nov. 7, 2016).

DISCLOSURE: Disclosure of this information to Treasury is required in order to comply with the requirements the American Rescue Plan Act of 2021.
Disclosure of this information is voluntary, however, grantees/recipients that do not disclose contact information will be unable to communicate with Treasury
oni issues related to their obligations under the Act and this may affect the status of their award,