PHA Plan Table Library

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1 PHA Plan Component 7 Capital Fund Program Annual Statement Parts I, II, and III Annual Statement Capital Fund Program (CFP) Part I: Summary Capital Fund Grant FFY of Grant Approval: (09/2010) X Original Annual Statement Line No. Summary by Account Total 1 Total Non-CGP Funds Operations Management Improvements , Audit 5, Liquidated Damages Fees and s 80, Site Acquisition Site Improvement 148, Dwelling Structures 788, Dwelling Equipment-Nonexpendable 100, Nondwelling Structures Nondwelling Equipment 105, Demolition Replacement Reserve Moving to Work Demonstration Relocation s Mod Used for Contingency 217, Amount of Annual Grant (Sum of lines 2-19) 2,724, Amount of line 20 Related to LBP Activities 22 Amount of line 20 Related to Section 504 Compliance 23 Amount of line 20 Related to Security 24 Amount of line 20 Related to Energy Conservation Measures

2 Annual Statement Capital Fund Program (CFP) Part II: Supporting Table /Name HA-Wide Activities General Description of Major Work Categories Account Total NC2-6/Glenwood Apartment Renovations ,253 NC2-38 Scattered Sites Painting 1460 HA-Wide Carpet Compliance 1460 PM&E ,000 Vinyl Flooring 1460 Lead Base Paint/Mold 1460 Landscape 1450 Gutters 1460 Cabinet Replacement 1460 Countertop Replacement 1460 VCT Replacement ,000 Signs 1450 Sidewalk Replacement ,000 Unit Repairs 1460 Tub Re-Glazing Bathroom Renovations Vanity Replacement ,500 22,750 Trees (Replacement and Pruning) ,224 Siding Low-Flow Plumbing Fixtures Operations Management Improvements Audit A & E Fees & s Appliances Non-Dwelling Buildings Non-Dwelling Equipment Computer Equipment Vehicles Relocation Contingency , ,118 5, ,000 15, ,953

3

4 Annual Statement Capital Fund Program (CFP) Part III: Implementation Schedule /Name HA-Wide Activities All Funds Obligated (Quarter Ending Date) All Funds Expended (Quarter Ending Date) NC2-6 Glenwood Scattered Sites HA-Wide

5 Optional Table for 5-Year Action Plan for Capital Fund (Component 7) Complete one table for each development in which work is planned in the next 5 PHA fiscal years. Complete a table for any PHA-wide physical or management improvements planned in the next 5 PHA fiscal year. Copy this table as many times as necessary. Note: PHAs need not include information from Year One of the 5-Year cycle, because this information is included in the Capital Fund Program Annual Statement. Name HA-Wide, Scattered Sites NC2-15 Carriage House Description of Needed Physical Improvements or Management Improvements NC2-15 Carriage House: Apartment Renovations Scattered Sites: Painting Carpet 504 Compliance PM&E Vinyl Flooring Lead Base Paint/Mold Landscape Gutters Cabinet Replacement Countertop Replacement VCT Replacement Signs Sidewalk Replacement Unit Repairs Tub Re-Glazing Bathroom Renovations Vanity Replacement Trees (Replacement and Pruning) Siding Low-Flow Plumbing Fixtures in 268,253 45,000 40,000 35,000 7,500 22,750 22,224 76,456 Planned Start Date (HA Fiscal Year)

6 Name HA-Wide, Scattered Sites NC2-15 Carriage House Description of Needed Physical Improvements or Management Improvements NC2-15 Carriage House: Apartment Renovations Scattered Sites: Painting Carpet 504 Compliance PM&E Vinyl Flooring Lead Base Paint/Mold Landscape Gutters Cabinet Replacement Countertop Replacement VCT Replacement Signs Sidewalk Replacement Unit Repairs Tub Re-Glazing Bathroom Renovations Vanity Replacement Trees (Replacement and Pruning) Siding Low-Flow Plumbing Fixtures in 268,253 45,000 40,000 35,000 7,500 22,750 22,224 76,456 Planned Start Date (HA Fiscal Year)

7 Name HA-Wide, Scattered Sties NC2-15 Carriage House Description of Needed Physical Improvements or Management Improvements NC2-15 Carriage House: Apartment Renovations Scattered Sites: Painting Carpet 504 Compliance PM&E Vinyl Flooring Lead Base Paint/Mold Landscape Gutters Cabinet Replacement Countertop Replacement VCT Replacement Signs Sidewalk Replacement Unit Repairs Tub Re-Glazing Bathroom Renovations Vanity Replacement Trees (Replacement and Pruning) Siding Low-Flow Plumbing Fixtures in 268,253 45,000 40,000 35,000 7,500 22,750 22,224 76,456 Planned Start Date (HA Fiscal Year)

8 Name HA-Wide, Scattered Sites NC2-15 Carriage House Description of Needed Physical Improvements or Management Improvements NC2-15 Carriage House: Apartment Renovations Scattered Sites: Painting Carpet 504 Compliance PM&E Vinyl Flooring Lead Base Paint/Mold Landscape Gutters Cabinet Replacement Countertop Replacement VCT Replacement Signs Sidewalk Replacement Unit Repairs Tub Re-Glazing Bathroom Renovations Vanity Replacement Trees (Replacement and Pruning) Siding Low-Flow Plumbing Fixtures in 268,253 45,000 40,000 35,000 7,500 22,750 22,224 76,456 Planned Start Date (HA Fiscal Year)

9 Name in Name in

10 Description of Needed Physical Improvements or Management Improvements Operations Management Improvements Audit A & E Fees & s Appliances Non-Dwelling Buildings Non-Dwelling Equipment Computer Equipment Vehicles Relocation Contingency Operations Management Improvements Audit A & E Fees & s Appliances Non-Dwelling Buildings Non-Dwelling Equipment Computer Equipment Vehicles Relocation Contingency 272,442 5, ,000 15, , ,442 5, ,000 15, ,953 Planned Start Date (HA Fiscal Year) Name in

11 Description of Needed Physical Improvements or Management Improvements Operations Management Improvements Audit A & E Fees & s Appliances Non-Dwelling Buildings Non-Dwelling Equipment Computer Equipment Vehicles Relocation Contingency Operations Management Improvements Audit A & E Fees & s Appliances Non-Dwelling Buildings Non-Dwelling Equipment Computer Equipment Vehicles Relocation Contingency 272,442 5, ,000 15, , ,442 5, ,000 15, ,953 Planned Start Date (HA Fiscal Year)

12 Optional Public Housing Asset Management Table See Technical Guidance for instructions on the use of this table, including information to be provided. Public Housing Asset Management Name,, and Location Identification and Type of units Capital Fund Program Parts II and III Component 7a Activities Component 7b Activity Description Demolition / disposition Component 8 Designated housing Component 9 Conversion Component 10 Homeownership Component 11a Other (describe) Component 17

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