Page1 form HUD (07/2014)

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1 Expires 06/30/07 Part I: Summary PHA Name: Des Moines Municipal Housing Agency 309 Euclid Ave Des Moines, IA 5030 Replacement Housing Factor Grant No: IA0R0507 Date of CFFP: FFY of Grant: 07 FFY of Grant Approval: Type of Grant Original Annual Statement Reserve for Disasters/Emergencies Revised Annual Statement (revision no: ) Performance and Evaluation Report for Period Ending: Final Performance and Evaluation Report Line Summary by Development Account Total Estimated Cost Total Actual Cost Total non-cfp Funds Original Revised Obligated Expended 406 Operations (may not exceed 0% of line ) Management Improvements 4 40 Administration (may not exceed 0% of line ), Audit 6 45 Liquidated Damages Fees and Costs Site Acquisition Site Improvement Dwelling Structures 465. Dwelling Equipment Nonexpendable 470 Non-dwelling Structures Non-dwelling Equipment Demolition 5 49 Moving to Work Demonstration Relocation Costs Development 4,500 3 PHAs with under 50 units in management may use 00% of CFP Grants for operations. 4 RHF funds shall be included here. Page form HUD (07/04)

2 Expires 06/30/07 Part I: Summary PHA Name: Des Moines Municipal Housing Agency Replacement Housing Factor Grant No: IA0R0507 Date of CFFP: FFY of Grant:07 FFY of Grant Approval: Type of Grant Original Annual Statement Reserve for Disasters/Emergencies Revised Annual Statement (revision no: ) Performance and Evaluation Report for Period Ending: Final Performance and Evaluation Report Line Summary by Development Account Total Estimated Cost Total Actual Cost Original Revised Obligated Expended 8a 8ba 50 Collateralization or Debt Service paid by the PHA 9000 Collateralization or Debt Service paid Via System of Direct Payment 9 50 Contingency (may not exceed 8% of line 0) 0 Amount of Annual Grant:: (sum of lines - 9) Amount of line 0 Related to LBP 5,000 (estimated) Amount of line 0 Related to Section Amount of line 0 Related to Security - Soft Costs 4 Amount of line 0 Related to Security - Hard Costs 5 Amount of line 0 Related to Energy Conservation Measures Signature of Executive Director Date Signature of Public Housing Director Date 3 PHAs with under 50 units in management may use 00% of CFP Grants for operations. 4 RHF funds shall be included here. Page form HUD (07/04)

3 Expires 06/30/07 Part II: Supporting Pages PHA Name: Des Moines Municipal Housing Agency CFFP (Yes/ No): Replacement Housing Factor Grant No: IA0R0507 Federal FFY of Grant: 07 General Description of Major Work Categories Development Account No. Quantity Total Estimated Cost Total Actual Cost Status of Work Original Revised Funds Obligated PHA Wide Admin 40,500 Funds Expended PHA Wide Future Acquisition of Scattered Sites 499,500 Page3 form HUD (07/04)

4 Expires 06/30/07 Part II: Supporting Pages PHA Name: Des Moines Municipal Housing Agency CFFP (Yes/ No): Replacement Housing Factor Grant No: IA0R0507 Federal FFY of Grant: 07 General Description of Major Work Categories Development Account No. Quantity Total Estimated Cost Total Actual Cost Status of Work Original Revised Funds Obligated Funds Expended Page4 form HUD (07/04)

5 Expires 06/30/07 Part III: Implementation Schedule for Capital Fund Financing Program PHA Name: Des Moines Municipal Hosing Agency Federal FFY of Grant: 07 All Fund Obligated (Quarter Ending Date) Original Obligation End Date Actual Obligation End Date 0/30/09 0/30/0 Original Expenditure End Date All Funds Expended (Quarter Ending Date) Actual Expenditure End Date Reasons for Revised Target Dates Obligation and expenditure end dated can only be revised with HUD approval pursuant to Section 9j of the U.S. Housing Act of 937, as amended. Page5 form HUD (07/04)

$ 40, $ $ Administration (may not exceed 10% of line 21)

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