Attachment G_Background Professional History.docx

ATTACHMENT G

BACKGROUND DISCLOSURE AND

PROFESSIONAL HISTORY AFFIDAVIT

REQUEST FOR APPLICATIONS (RFA) 9288

Qualified Appraiser List for Multifamily Affordable Housing Development

SECTION 1: PROFESSIONAL DISCIPLINARY HISTORY

1.1 Regulatory Actions or Disciplinary Proceedings

In the past FIVE (5) years, have you been subject to any of the following:

Appraiser license suspension, revocation, or restriction

Complaint or investigation by state appraiser board

Ethics complaint or finding by professional organization

USPAP violation or standards violation finding

Administrative action by federal housing agency

Other regulatory action

If yes to any of the above, provide details on separate pages with supporting documentation.

1.2 Professional Litigation or Legal Proceedings

In the past FIVE (5) years, have you been a party to any litigation related to professional work:

Malpractice lawsuit? ☐ Yes ☐ No If yes, describe: _____________________________________________________

Current status: ______________________________________________________

Breach of contract claim? ☐ Yes ☐ No

Other professional liability claim? ☐ Yes ☐ No

Provide details and court case numbers on separate pages.

1.3 Criminal History

Have you been convicted of any crime or felony in the past FIVE (5) years? ☐ Yes ☐ No

If yes, provide details (crime, date, jurisdiction, sentence):

Have you been convicted of any crime or felony in the past FIVE (5) years? ☐ Yes ☐ No

If yes, provide details (crime, date, jurisdiction, sentence):

SECTION 2: COMPLIANCE WITH LAWS AND REGULATIONS

2.1 Federal and State Law Compliance

Certify your compliance with:

☐ Federal tax laws (IRS reporting, employment taxes, etc.)

☐ Oregon tax laws (income tax, property tax, etc.)

☐ State appraiser license law and regulations ☐ USPAP standards and ethical requirements ☐ Federal affordable housing program requirements (IRC §42, 24 CFR §92, etc.)

☐ Oregon procurement law and regulations ☐ Nondiscrimination and equal opportunity laws ☐ Other applicable professional regulations

If unable to certify compliance with any of the above, describe:

2.2 Outstanding Citations, Violations, or Fines

Are there any outstanding:

Tax liens? ☐ Yes ☐ No

Wage/hour violations or Department of Labor citations? ☐ Yes ☐ No

OSHA violations or workplace safety citations? ☐ Yes ☐ No

Licensing board violations or fines? ☐ Yes ☐ No

Environmental violations? ☐ Yes ☐ No

Other regulatory violations? ☐ Yes ☐ No

If yes to any, describe:

SECTION 3: PROFESSIONAL REFERENCES AND BACKGROUND VERIFICATION

I authorize OHCS to:

☐ Contact my professional references to verify qualifications and work quality ☐ Conduct background checks through credit reporting agencies (if permitted by law) ☐ Verify my appraiser license status with Oregon DREF ☐ Search SAM.gov for debarment status ☐ Contact prior clients and employers to verify employment and performance ☐ Review prior appraisal reports for quality and USPAP compliance

I understand that OHCS may contact any individual or organization with knowledge of my professional background.

SECTION 4: BACKGROUND AFFIDAVIT

STATE OF OREGON

COUNTY OF [COUNTY NAME]

I, _________________________ (print name), declare under penalty of perjury that:

1. I am competent to make this affidavit.

2. I have reviewed all information provided in this RFA application and certify that all statements are true, accurate, and complete to the best of my knowledge.

3. I have disclosed all material facts regarding:

- Professional disciplinary history

- Regulatory violations or compliance issues

- Litigation or legal proceedings

- Criminal history or charges

- Any other matters that could affect my qualification to serve OHCS

4. I understand that false statements in this affidavit constitute perjury under Oregon law and may result in criminal prosecution.

5. I understand that material omissions or misrepresentations may result in:

- Disqualification from this RFA

- Removal from the approved appraiser list if approved

- Termination of services and Appraiser Services Agreement

- Referral for legal action or prosecution

6. I commit to:

- Maintaining professional integrity and ethical standards

- Complying with all applicable laws, regulations, and professional standards

- Providing accurate, unbiased, and professional appraisal services

- Notifying OHCS of any changes to my professional status or circumstances

Signature: _________________________________ Date: __________________

Printed Name: ___________________________________________________

Title: ________________________________________________________________

Business Name: ____________________________________________________

Notarization (Optional but Recommended):

Subscribed and sworn to before me this __________ day of _______________, 202__.

Notary Public Name (Print): _____________________________________________

Notary Signature: ____________________________

Notary Public Commission Number: _____________________________________________

Commission Expiration Date: _____________________

SECTION 5: DISCLAIMER AND AUTHORIZATION

By signing below, I authorize OHCS and any authorized third parties to conduct background verification and reference checks, and I acknowledge that:

1. I have read and understand the terms of this RFA

2. I authorize release of information necessary to verify my qualifications

3. I understand OHCS may verify any information provided

4. I waive confidentiality for information necessary to verify my background

Applicant Signature: _________________________ Date: __________________

END OF ATTACHMENT G

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