Mansions East Lease Application Check List

Mansions East Lease Application Check List Lease Start Date: Lease End Date: Lessee Name: Lessee Name: Agent Contact Information: Check List Needed for Lease Master Association Check - $200.00 Made payable to "Evergrene Master Association, Inc." COA Check - $100.00 Made payable to "Mansions East". (additional $70.00 for each adult residing on property over the age of 18 for background check). Completed application for Lessee Membership Lessee Registration Form Affidavit of Receipt of HOA/COA Documents (Notarized) Terms and Conditions of Lessee Membership Authorization for Consent of Background Investigation Copy of Addendum to Contract Pet Registration Form Veterinarian Certification Consent, Waiver, Release and Indemnification Agreement Copy of Lease Contract Notes: Page 1 of 14

MANSIONS EAST AT EVERGRENE Lease Application Instructions After you receive approval from the Mansions East Board of Directors and the Certificate Of Approval has been issued, it will be forwarded to the Evergrene Master Association at the Club House, 650 Evergrene Parkway. You (your tenant) must complete their application prior to Security allowing access into the property. A copy of the Certificate of Approval must be presented to the Evergreen Master Association when your tenant is applying, be sure your tenant has a copy of the Certificate Of Approval to take with them. Complete the following forms: Note. Homeowner must also sign this Application. Rental agent s signature is not acceptable. Lease Application Signed Acknowledgments of agreement from homeowner and applicant Lessee Registration Form Pet Registration Form (With veterinarian certificate and picture of pet attached) Below items must be attached to the Application package: a) Photo ID Photo must be visible for each applicant b) Copy of the lease contract (With the below clauses included in the Lease) The Condominium Association s Documents require that all lease contracts have within it the following verbiage: The Association shall have the right to: a. Terminate the lease for failure of the renter to follow the Documents and Rules & Regulations adopted by the Association, and b. To collect all rental payments due to the owner and to apply same against unpaid assessments if the owner is in arrears in payment of Assessments and/or other charges. c) $100.00 non-refundable check - for the application fee made payable to The Mansions East (Additional $70.00 for each adult applicant for background check.) Return completed signed Application and required attachments to: Evergrene Master Association, Inc. 650 Evergrene Parkway Palm Beach Gardens, FL 33410 Phone (561)626-1981 Fax (561)626-7186 HOA requires interview with applicant 10 business days PRIOR to lease start date. Once all of the above has been completed and the signed paperwork has been received, an orientation will be scheduled, after the orientation, a Certificate of Approval will be provided. Page 2 of 14

MANSIONS EAST at EVERGRENE COA LEASE APPLICATION Evergrene Master Association, Inc. 650 Evergrene Parkway, Palm Beach Gardens, FL 33410 PHONE: (561)626-1981 FAX: (561)626-7186 Date: Lease Address: Lease Term: APPLICANT(S) INFORMATION: If unrelated, please provide for each applicant. Applicant #1: Name: Email: Telephone # s: Social Security #: Date of Birth: Applicant #2: Name: Email: Telephone # s: Social Security #: Date of Birth: Please name all Occupants Relationship to Lessee 1. 2. 3. 4. LICENSED DRIVERS: To be residing in the community Name: License #: State: Name: License #: State: Name: License #: State: Name: License #: State: PERSONAL REFERENCES: (Do not list relatives) Name: Address: Name: Address: Phone: Phone: RESIDENCE HISTORY: If less than 5 years, provide previous residence information on separate sheet Address: City: State: Zip: Page 3 of 14

Address: City: State: Zip: Address: City: State: Zip: WORK HISTORY: Applicants 1 and 2. If less than 5 years, provide previous employer information. Employer: Phone: Address: Position: Employment Dates: Applicant 1 Applicant 2 EMERGENCY CONTACT INFORMATION: SECURITY BACKGROUND I UNDERSTAND A NATIONWIDE LAW ENFORCEMENT INVESTIGATION IS REQUIRED AND WILL BE DONE. Have you (or other applicant) ever been convicted of a state or federal offense? Yes No Have you (or other applicant) ever been convicted of a felony in the past 7 years? Yes No Are you (or other applicant) presently awaiting trial on any criminal offense? Yes No IF YES TO ANY OF THE ABOVE, GIVE APPLICANT S NAME, DATES, NAME OF COURT AND DETAILS OF CONVICTION ON A SEPARATE SHEET AND ATTACH. ============================================================================================= ACKNOWLEDGEMENT OF OWNER(S) 1. That I/We hereby authorize the Association to evict a tenant at my/our (owners) expense in any case where the tenant fails to abide by the Association s Governing Legal Documents and Rules & Regulations, receipt of which is hereby acknowledged. 2. That I/We as Owner(s) are responsible for the tenant and/or guests of such tenant, in regard to unpaid violation fines, any costs related to damages to community property and/or fees paid to the Association s attorney relating to tenant and/or guests of tenant and agree upon receipt of Notice that all monthly rent payments will be sent directly to the Association by the tenant until any assessments, charges, late fees and/or attorney fees, due and owing the Association by the owner/landlord are paid in full, pursuant to section 18.8 of the Mansions East Condominium Association, Inc. Declaration. Signature of Owner: Signature of Owner: Date: Date: Page 4 of 14

ACKNOWLEDGEMENT BY APPLICANT(S) By signing below, I/We hereby certify: 1. That I/We agree on behalf of all persons who may use the unit, which I seek to lease and myself, that I/We will abide by all the Restrictions in the By-Laws, Rules and Regulations, and Association Documents. 2. That I/We agree that all of the information contained in the application is true and complete and that any False or Misleading information given in this application constitutes grounds for rejection of this application and revocation of my right to reside on this property. 3. That I/We give my/our permission for a Nationwide Law Enforcement Background investigation and credit history verification. 4. That no persons other than those shown on this application will reside in the unit and I/We agree that anyone moving into the unit at a later date will be registered with the Association and a background investigation done at the applicant s expense. 5. I/we acknowledge that I/we have received, read, understand and agree to abide by the Mansions West Documents and the Rules & Regulations, and the Association may terminate the lease for failure to follow the Documents and Rules & Regulations adopted by the Board of Directors. 6. I/We understand and agree that upon receipt of Notice from the Association Management that my/our monthly rent payments will be sent directly to the Association until any assessments, charges, late fees and attorney fees, due and owing by the owner/landlord are paid in full, pursuant to 18.8 of the Mansions East Condo. Assoc., Inc. Declaration. Signature of Applicant 1: Signature of Applicant 2: Signature of Witness: Date: Date: Date: Page 5 of 14

Lessee Registration Form Evergrene Property Address: Applicant 1 First and Last Name: Applicant 2 First and Last Name: Telephone Number: Cell Phone Number: E-Mail Address: By submitting your e-mail address to be the primary source of communication. You are authorizing all correspondences and meeting notices associated with Evergrene to be sent to this e-mail address. This information will not be used for any other purpose Other Residents: Please list anyone living with you. This would include all family members. First Name Last Name Date of Birth Phone Number Relation Vehicle Information Make / Model Year Color Tag Number State Please list family members and guests you wish to allow permanent access to your property without prior notice. Your guests must present proper identification. If your guest is not on the permanent list, the Gate will call you for permission to allow this guest entry. PERMANENT GUESTS PERMANENT GUESTS Page 6 of 14

EVERGRENE MASTER ASSOCIATION, INC. Affidavit of Receipt of Association Documents (All documents are available on our community website, www.evergrene.com) This is to certify that I, intend to lease and that accordingly, I have received the Master Declaration of Covenants, Conditions and Restrictions and the Rules and Regulations for Evergrene Master Association, Inc. and for the Mansions East Condominium Association, Inc. This is certified to be so by: Lessee Signature STATE OF FLORIDA COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me the day of, 20 by who is personally known to me or who produced as identification and who did (not) take an oath. My Commission Expires: Notary Public State of Florida at Large Page 7 of 14

TERMS AND CONDITIONS OF LESSEE MEMBERSHIP The parties hereby acknowledge that the Applicant is the exclusive legal tenant under the terms of the attached Lease Agreement and that the undersigned Applicant desires to utilize Owner's Membership (the "Membership") in the Evergrene Club (the "Club") during the term of the Lease Agreement. The parties hereby acknowledge and agree that the Applicant's Membership rights shall expire upon the expiration of the Lease Agreement. Owner acknowledges that, upon Club Owner's approval of this Application, Owner will have transferred Owner's Membership rights to the Applicant during the term of the Lease Agreement and will not have access rights nor any other Membership rights to the Club in accordance with the Club Documents (as herein defined) during the term of the Lease Agreement. Owner acknowledges that, upon Club Owner's approval of this Application, Owner will remain liable to the Club Owner for all Club Dues and Shared Club Expenses arising during the term of the Lease despite transferring all Membership rights in the Club to Applicant during the term of the Lease. Applicant acknowledges that the Club Owner may suspend the Applicant's Membership privileges if Owner fails to pay Club Dues in connection with the Leased Residence. Applicant acknowledges that Owner may suspend or revoke the Applicant's Membership privileges for cause. Such cause may include, but not be limited to, repeated violation of the restrictions set forth in the Club Documents, failure of Applicant to stay current with any Club accounts, or for violation of the Lease Agreement. Owner and Applicant hereby acknowledge and agree that the Owner has provided the Applicant current copies of the Club Plan for Evergrene Community and the Evergrene Club Rules and Regulations (collectively the "Club Documents") and that the Applicant has read, understands and agrees to be bound by their terms and conditions, as supplemented by this Application. Moreover, Applicant acknowledges that the Club Documents contain extensive rules and restrictions including, but not limited to, restrictions on guests, children, pets and activities. Applicant further acknowledges that Applicant has the right to consult with an attorney in connection with the execution of this Application, and that Applicant has consulted with an attorney to the extent Applicant believes such advice is necessary. Applicant acknowledges that the Membership will be personal to Applicant, is non-transferable, and will not permit use of the Club Facilities by anyone other than the Applicant, except as a guest and subject to the Club Documents. Applicant hereby acknowledges that the use of the Club Facilities and any privilege or service incident to membership is undertaken with knowledge of possible risk of injury. Applicant hereby assumes and accepts any and all risk of injury that the Applicant, the Applicant's guests or family may sustain while using the Club Facilities or involved in any event or activity incident to membership in the Club. Applicant shall hold the Club, Club Owner, Evergrene Master Association, Inc. and it's successors and assigns, their affiliates, partners, directors, governors, officers, members, employees, representatives and agents (the "Released Parties") harmless from any and all loss, cost, claim, injury, damage or liability sustained or incurred by him or her, resulting therefrom and/or from any act or omission of any affiliate, partner, director, governor, officer, member, employee, representative or agent of the Club, Club Owner, or Evergrene Master Association, Inc. Applicant shall have, owe and perform the same obligation to the Released Parties in respect to any such loss, cost, claim, injury, damage or liability sustained or incurred by any guest or family member of the Applicant. Applicant hereby acknowledges that the Club may use photographs taken of the Applicant and other users at the Club and statements made by the Applicant at the Club for Club and/or Evergrene Community publications without Applicant's prior approval. This Application may not be amended or modified, nor shall any waiver of any provision hereof be effective, except by an instrument in writing executed by the Applicant and the Club. All capitalized terms not herein defined shall have the meaning provided in the Documents or in the Declaration of Covenants, Conditions and Restrictions for Evergrene Community. This Application shall be governed by and construed and enforced in accordance with the laws of the State of Florida without giving effect to principles of conflicts of law. Page 8 of 14

I, the Applicant, hereby request to utilize Owner's Membership in the Club during the term of the Lease Agreement and authorize the disclosure and release of information to the Club for investigating my qualifications for membership and authorize those persons or entities named herein to furnish personal and financial information about me to the Association. Signature of Applicant Printed Name of Applicant * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * I, the Owner, hereby authorize the Applicant to utilize my Membership in the Club during the term of the Lease Agreement and request that the Club Owner grant the Applicant all rights, privileges and responsibilities associated with my Membership during such period, subject to the provisions of the Club Documents. Signature of Owner Printed Name of Owner * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Evergrene Club This Application for Lessee Membership shall not be binding upon the Club until the acceptance below is signed. Such acceptance is subject to the Owner's current payment of the HOA fees and the application fee in the amount of $200.00. Approved and Accepted by: Evergrene Master Association, Inc. By: Printed Name: Title: Page 9 of 14

Authorization for Consent to Background Investigation CONSENT TO BACKGROUND INVESTIGATION The undersigned authorizes Evergrene Master Association, Mansions East and Mansions West to order Financial Credit, Criminal & Sex Offender Reports and conduct Rental & Employment Investigations, and to furnish it to the appropriate property owner and/or association to assist in the review process with the understanding that payment for the reports is the responsibility of the lessee. I agree that the foregoing information is true and correct and may terminate any agreement entered into based on any misstatement made herein. I will indemnify and hold harmless Campbell Property Management, Evergrene Master Association, Mansions East, and Mansions West, its agents and representatives from any action, legal or otherwise, regarding the collection and dissemination of any information furnished by reporting services and/or collected during the background search authorized by the applicant/(s) herein. I release from liability any company or person providing information authorized by me herein. Date Signature Date Signature Page 10 of 14

Addendum to Contract Addendum to the Contract dated between (Owner) (Tenant) Concerning the property as (Property Address) (the Contract ) Owner and Tenant make the following terms and conditions part of the Contract: The Association shall have the right to A.) Terminate the lease for failure of the tenant to follow the Documents and Rules and Regulations adopted by the Association, and per Florida Statue 720. B.) To collect all rental payments due to the owner and to apply same against unpaid assessments if the owner is in arrears in payment of assessments and/or other charges. Date Owners Signature Date Owners Signature Date Tenant Signature Date Tenant Signature Page 11 of 14

PET REGISTRATION FORM I do not own a pet Signature: Owner Information Name: Address: Phone: Pet Information Type of Pet Breed Color Weight Name 1. Rabies Certification Number: Is the pet micro chipped? Yes No Micro Chip # Required Certification from Veterinarian verifying pet weight and vaccines Type of Pet Breed Color Weight Name 2. Rabies Certification Number: Is the pet micro chipped? Yes No Micro Chip # Required Certification from Veterinarian verifying pet weight and vaccines Type of Pet Breed Color Weight Name 3. Rabies Certification Number: Is the pet micro chipped? Yes No Micro Chip # Required Certification from Veterinarian verifying pet weight and vaccines Page 12 of 14

CONSENT, WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT FOR USE OF THE CLUB AT EVERGRENE FACILITIES Name: (hereinafter referred to as the Undersigned ) Address: Over Age 18: Yes No The Undersigned, as a condition to entering and/or using the Club Facilities of the Club at Evergrene (the Club ), understands and agrees to the terms herein and makes the following Representations and Warranties: (i) the Club Facilities include the Club building, parking areas around the Club, Fitness Center and lockers, pools and pool decks ( Club Facilities ); (ii) the Club is not responsible for any loss or damage to any private property of any kind whatsoever, used or stored in the Club Facilities, including but not limited to all risk of loss respecting motor vehicles, bicycles, equipment, jewelry or other possessions; (iii) the use of any apparatus, appliance, swimming pool, facility, privilege or service whatsoever owned, leased or operated by the Club, or participation in any contest, game, function, exercise, competition or other activity operated, organized, arranged or sponsored by the Club, either on or off the Club Facilities, is at the sole risk of the Undersigned and the Club is not responsible for and is released from any and all action, injuries, claims, losses, liabilities, damages, costs and expenses of any kind or nature whatsoever respecting any personal injury or death occurring at the Club or respecting Club Facilities; (iv) there may be no adult supervision and there are no lifeguards on duty at the swimming pool; (v) the Undersigned has consulted with a physician regarding any health implications to the Undersigned as a result of use of the Fitness Center and the Undersigned has been advised by said physician that s/he is physically well enough to use the Fitness Center; (vi) the Undersigned shall be solely responsible for the supervision of any minors admitted into the Club Facilities accompanying the Undersigned, and shall be responsible to the Club for any damage caused by such minors; and (vii) failure to pay Association Dues and/or to abide by the Evergrene Master Association Rules and Regulations may result in suspension of the Undersigned s right to use the Club Facilities. Page 13 of 14

The Undersigned does hereby unconditionally, fully, and completely release the Club at Evergrene, Evergrene Master Association, Inc., and all sub-associations (the Released Parties ), and all of the current, previous, and future officers, directors, attorneys, agents, employees, and servants of any of the Released Parties, and also including any and all persons or entities who might have or claim to have rights of recourse or claims for indemnity or contribution against any of the Released Parties, from all and every manner of causes of action, claims, suits, controversies, liabilities, trespasses, damages, judgments, executions, and demands whatsoever, whether in law or in equity, whether civil, legal, ethical, moral, or otherwise, which the Undersigned has, can, shall, or may have in the future, both known and unknown, against any person or entity comprising the Released Parties for, upon, or by reason of any matter, cause, or thing whatsoever respecting or resulting from the use of the Club Facilities by the Undersigned including but not limited to the negligent acts or omissions of any of the Released Parties or any other person using the Facilities, and specifically including but not being limited to claims or liabilities arising from the death of or personal injury to the undersigned, all of which are waived. The Undersigned shall hold the Released Parties harmless and indemnify the Released Parties from all loss, liability, claims, and expense, including reasonable attorneys and paraprofessional fees, costs, expenses not otherwise taxable as costs, and accountants and other experts fees, whether or not taxable under applicable court rules, incurred in the defense of any such claim (whether in a court of original jurisdiction or one or more courts of appellate or other jurisdiction), made by or asserted by the Undersigned, or any person who may acquire subrogation rights respecting any claim by the Undersigned, including but not limited to any insurer, and/or arising out of the failure of the Representations and Warranties to be true at any time that the Undersigned uses the Club Facilities. The Undersigned acknowledges that the Club at Evergrene would not have accepted this Consent or permitted the Undersigned to use the Club Facilities without the Undersigned agreeing to the Representations and Warranties and the warranties and indemnities provided in this Consent. Dated this day of, 20. Signature: Printed Name: Page 14 of 14