HUD-9612 FHA Single Family Loan Sales Qualification Statement Add

OMB Control Number: 2502-0576
Expiration Date: XX-XX-XXXX

FHA SINGLE FAMILY LOAN SALES QUALIFICATION STATEMENT
ADDENDUM FOR NONPROFIT AND GOVERNMENT POOLS AND SUB-POOLS
NOTE: This Qualification Statement Addendum is applicable ONLY to the FHA Single
Family Loan Sale pools of forward or reverse Mortgage Loans, as applicable, that are
designated for Nonprofit and Government bidders only (“Nonprofit and Government
Pools”) and any sub-pool of loans in the Sale (“Nonprofit and Government Sub-Pools”), if
applicable.
The information requested herein is being requested for the purpose of providing HUD with
information needed to determine whether the Bidder meets the qualification requirements to bid
in the Sale. All or part of the information provided on this form may also be subject to disclosure
under the Freedom of Information Act, 5 U.S.C. § 552(a) (“FOIA”). Pursuant to HUD’s FOIA
regulations at 24 C.F.R. § 15.108, you may request confidential treatment of business
information submitted in connection with this form and support such request with the facts and
the legal justification for such request. Any request for confidential treatment must state that the
information has not been made public and clearly designate the information that is considered
confidential. Should HUD receive a FOIA request for such confidential information, HUD will
provide you with notice of the request and an opportunity to object to the disclosure in
accordance with HUD’s regulations, unless disclosure is required by federal law. Providing the
requested information is voluntary; however, failure to furnish all of the requested information
may result in the prospective purchaser not being permitted to bid at the Sale and/or not receiving
notice of future HUD/FHA sales initiatives.
NOTICE: Anyone who knowingly or willfully makes false or fraudulent statements or
representations in connection with the disclosures or certifications herein will be referred
to the Office of Inspector General and/or the appropriate law enforcement officials for
investigation and legal enforcement and may be subject to fines, imprisonment or both.
See 18 U.S.C. §§ 1001, 1010, 1012.

Qualification Statement Addendum for Nonprofit and Government Pools and Sub-Pools

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HUD Form 9612 (6/2020)

NOTE: The following information is being solicited with respect to the individual or entity
that will submit a bid in the Sale to acquire the Mortgage Loans.
1. Bidders must check one or more of the following statements in subsection A. and one or more
of the following statements in subsection B. to be considered for approval as a “qualified
bidder” for any Nonprofit and Government Pools and Nonprofit and Government Sub-Pools, if
applicable. (CHECK ALL THAT ARE APPROPRIATE):
A. Entity Structure
( __ ) i. Bidder is a nonprofit that is tax-exempt under Section 501(c)(3) of the Internal
Revenue Code of 1954 (26 U.S.C.A. § 501(c)(3)).
( __ ) ii. Bidder is a joint venture involving a 501(c)(3) organization (a “Nonprofit Joint
Venture”), and the 501(c)(3) organization’s control over the Nonprofit Joint Venture is
sufficient for a determination that the Nonprofit Joint Venture operates in a manner
consistent with the 501(c)(3) organization’s charitable purpose.
( ___ ) iii. Bidder is a Nonprofit Instrumentality of Government. This is a 501(c)(3)
organization that was established by a governmental body or with governmental approval
under special law to serve a particular public purpose, or is designated an instrumentality by
law.
( __ ) iv. Bidder is a Governmental Entity or an Instrumentality of Government.
Governmental Entity refers to any federal, state, or local government agency or
instrumentality. An Instrumentality of Government refers to an entity that was established
by a governmental body or with governmental approval or under special law to service a
particular public purpose or designated by law and does not have a 501(c)(3) status.
(___) v. Bidder is a joint venture involving a Governmental Entity that has been established
in order to carry out the Governmental Entity’s purpose (a “Governmental Joint Venture”).

Qualification Statement Addendum for Nonprofit and Government Pools and Sub-Pools

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HUD Form 9612 (6/2020)

B. Net Worth
( __ ) i. Bidder has a net worth of $3,000,000 determined in accordance with Generally
Accepted Accounting Principles, consistently applied (“GAAP”), and except for a
Bidder that is Nonprofit Joint Venture or a Governmental Joint Venture, Bidder was not
formed for the specific purpose of acquiring an interest in the Mortgage Loans.
In lieu of having a net worth of $3,000,000, Bidder may provide either an Irrevocable
Letter of Credit in the form of a firm commitment and for the benefit of the government
or Performance Bond (both as described more fully below) in the amount of $3,000,000.
If Bidder is the high bidder, before the award will be made by HUD, Bidder must be
able to show evidence that the Irrevocable Letter of Credit or Performance Bond is in
place within two (2) business days of the notice that it is the high bidder. The
Irrevocable Letter of Credit or Performance Bond must be valid through thirty (30) days
after the final settlement date for all loans purchased. The Irrevocable Letter of Credit or
Performance Bond must meet the following criteria:
Irrevocable Letter of Credit: The Letter of Credit shall be from a financial institution
the long-term senior unsecured debt of which shall have a credit rating of not less than
“A” from Standard & Poor’s Corporation and not less than “A2” from Moody’s
Investors Service, Inc.
Performance Bond: The Performance Bond shall be supported by corporate sureties
whose names appear on the list contained in Treasury Department Circular 570,
individual sureties, or by other acceptable security such as postal money order, certified
check, cashier’s check, irrevocable letter of credit, or, in accordance with Treasury
Department regulations, certain bonds or notes of the United States. Treasury Circular
570 is published in the Federal Register, or may be obtained from the:
U.S. Department of Treasury
Financial Management Service
Surety Bond Branch
3700 East West Highway, Room 6F01
Hyattsville, MD 20782
Or via the internet at https://fiscal.treasury.gov/surety-bonds/circular-570.html.
( __ ) ii. Bidder can provide an Irrevocable Letter of Credit as described above.
( __ ) iii. Bidder can provide a Performance Bond as described above.
2. IRS Tax-Exempt Status. Please submit an IRS Determination Letter providing an effective
date of exemption that is at least two years prior to the execution date of this Certification, or the
reason such a letter is not applicable (e.g., Governmental Entity or its Instrumentality of
Government is not a 501(c)(3) organization).

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Qualification Statement Addendum for Nonprofit and Government Pools and Sub-Pools
HUD Form 9612 (6/2020)

3. Organizational Chart. Please provide an organizational chart that graphically depicts the board
of directors, employees and all entities and contemplated partners and their respective ownership
percentages within the Bidder. This chart should show the contractual or equity relationships.

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Qualification Statement Addendum for Nonprofit and Government Pools and Sub-Pools
HUD Form 9612 (6/2020)

Sections 4 through 7 are not applicable to Governmental Entities, Instrumentalities of
Government, Nonprofit Instrumentalities of Government, and Governmental Joint
Ventures. HUD reserves the right to request additional documentation to support
nonprofit Bidder’s certifications. For Nonprofit Joint Ventures, the participating
nonprofit must provide the following certifications or must attach a separate document
containing these certifications to this Qualification Statement Addendum. If the
participating nonprofit cannot certify to any subsection of Sections 4, 5, or 6 below, please
describe and explain in an attached document not to exceed one page the circumstances
or other information that may render such failure to certify immaterial for the purposes
of the Nonprofit Joint Venture qualifying for the Sale.
4. The nonprofit certifies that:
i. each member of the nonprofit’s Board of Directors (“board member”)
serves in a voluntary capacity and does not receive compensation for any
services they provide in the implementation of the nonprofit's program (may
receive reimbursement for expenses);
_____ii. no part of the nonprofit’s earnings are passed on to a board member,
corporation, or other entity affiliated with a board member, and board members
are not employees of the nonprofit; and
_____iii. the occupations, activities and obligations of each board member do not
conflict with the work of the nonprofit.
5. The nonprofit certifies that:
i. no conflict of interest exists between the board members, principal staff,
or any other entities that may participate in the management and disposition of
the assets purchased in the Sale;
ii. its staff does not also work for and receive financial benefits from a for-profit
entity that is providing the nonprofit with services related to the management
and disposition of assets purchased in the Sale; and
iii. it has a minimum of two consecutive years of relevant experience
earned within the last five years in the servicing, management, and
disposition of defaulted mortgage loans.
6. The nonprofit’s operations must be independent of the influence, control or direction of
the consultant or any outside party, particularly those seeking to derive profit or gain from a
proposed project. The nonprofit certifies that:
i. its operations are independent of the influence, control or direction of any
consultant or outside party;
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Qualification Statement Addendum for Nonprofit and Government Pools and Sub-Pools
HUD Form 9612 (6/2020)

_ ii. that its consultants – administrative, management, financial, or otherwise - provided
under an independent contractor relationship are arm’s length and do not constitute
more than half of the nonprofit’s activities; and
_ iii. it has the in-house resources and capacity to operate its own program, and contracts
for services only on a temporary or supplementary basis.
If a nonprofit cannot certify to any subsection of Section 7 below, please describe and
explain in an attached document not to exceed one page the debarment, suspension, or
other exclusion and any extenuating circumstances or other information that may render
such debarment, suspension or exclusion immaterial for the purposes of qualifying for the
Sale. Please provide a copy of any order or agreement imposing such debarment,
suspension or exclusion.
7. The nonprofit represents and warrants that it, its Related Entities, and its staff are not any of
the following:
i. an individual or entity that has been indicated for, or convicted of, an offense
which
reflects upon the responsibility, integrity, or ability of the nonprofit to participate in
FHA activities;
ii. an individual or entity that has unresolved findings from HUD
or other governmental investigation, audit, or review; or
iii. an individual or entity engaged in business practices that do not conform to generally
accepted practices of prudent nonprofits or that demonstrate irresponsibility.
8. ________ Bidder acknowledges and agrees that FHA/HUD has the right to request additional
or updated information at any time, including, without limitation, financial statements and/or
confirmation of the representations, warranties and certifications made herein. Bidder authorizes,
and has the authority to authorize, FHA/HUD and its agents to conduct credit and other
investigations of Bidder through appropriate third-party reporting agencies. Bidder further
acknowledges and agrees that FHA/HUD may, in its sole discretion, refuse to qualify any
prospective bidder who, in FHA/HUD’s sole judgment, does not have the requisite knowledge
and experience to evaluate the merits and risks of purchasing and to make an informed decision
with respect to the purchase of the Mortgage Loans.
9. ________ Bidder hereby certifies that to the best of Bidder’s knowledge all the information
stated herein, as well as any information provided in the accompanying documents (if
applicable), is true, accurate, and complete. Submission of false information in connection with
this application is grounds for rejecting your bid or invalidating the Conveyance, Assignment
and Assumption Agreement. Bidder further certifies that Bidder has read the Warnings set forth
below.
10. ________ Bidder hereby certifies that it is submitting this Qualification Statement
Addendum with the goal of purchasing one or more Nonprofit and Government Pools or SubQualification Statement Addendum for Nonprofit and Government Pools and Sub-Pools

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HUD Form 9612 (6/2020)

Pools and resolving the loans acquired in such pools or sub-pools in a manner furthering the
501(c)(3) charitable purpose or government purpose of the Bidder or its joint venture partner, as
noted in Section 1.A. above.
WARNING: Any person who knowingly presents materially false, fictitious, or fraudulent
statements in a matter within the jurisdiction of HUD is subject to penalties, sanctions, or other
regulatory actions, including but not limited to:
(i) Fines and imprisonment under 18 U.S.C. §§ 287, 1001, 1010, 1012, which provides
for fines of a maximum of $25,000 for individual and $500,000 for organizations or
imprisonment for up to five years or both; or
(ii) Civil penalties and damages under 31 U.S.C. § 3729, of not less than $5,000 and not
greater than $10,000 plus three times the amount of damages which the
government sustains; and
(iii)Administrative sanctions, claims, and penalties by HUD pursuant to 24 C.F.R. Parts
24, 28, and 30.
The Bidder and the person signing on behalf of the Bidder certify that the information provided
on this form and in any accompanying documentation is true and accurate

Dated: ____________________ , 20__
BIDDER:

By: ________
Printed Name:
Print Title:
IF THE NONPROFIT IS NOT THE BIDDER ENTITY:
NONPROFIT:
By: ________
Printed Name:
Print Title:

Qualification Statement Addendum for Nonprofit and Government Pools and Sub-Pools
HUD Form 9612 (6/2020)

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