Hayward Rent Crisis Mediation Request

Hayward Rent Crisis Mediation Request

Introduction and overview
In response to the global COVID-19 pandemic and State and county “stay-at-home” and other emergency orders, on March 24, 2020, Hayward City Council enacted an Emergency Ordinance establishing a temporary moratorium on evictions in the City of Hayward for non-payment of rent caused by the Coronavirus (COVID-19) Pandemic, or for no-fault evictions and providing tenants and landlords mediation services to negotiate payment agreements. On April 7th the temporary moratorium was expanded to prevent displacement of residential and commercial tenants impacted by the COVID-19 pandemic. However, mediation services are only available to negotiate repayment of rent for residential properties.

By completing this questionnaire, Tenants or Landlords can request assistance negotiating reduced rental amounts during the moratorium period and/or repayment of unpaid rent during the moratorium period. All personal information provided will be kept confidential and not reported to any funding source or government agency.

Process overview:

Step 1: Tenant informs Landlord of their financial hardship that may impact their ability to pay rent.

Step 2: Tenant or Landlord submits this form to request mediation assistance.

Step 3: Project Sentinel will contact the Requesting Party within 48 hours and assign the case to a professional mediator.

Step 4: The assigned mediator will first contact the Tenant and the Landlord by phone. The mediator will talk with both parties separately on the phone and may use phone or video conferencing to speak with both parties at the same time.

Step 5: If an agreement or plan is reached, the mediator will put the plan the parties agreed to in a form.

Step 6: Project Sentinel will send the completed form to both parties to sign.

The mediation program is fast, free and confidential!

If you have questions about filling out this form or submitting a request for mediation you can contact Rent Review Office staff at 510-583-4454 or by email at housing@hayward-ca.gov .

Hayward Moratorium Presentation

Hayward Rent Crisis Mediation Request

Rental Information
1. Rental Property/Unit Address *

Street Address

Street Address Line 2

Postal / Zip Code
2. Rental Rate (current monthly rent) *
3. Date of last rent increase (if known)
4. Last rent increase amount ($ and/or %)
5. I am a *

Tenant Landlord/Property Manager
6. What amounts has Tenant paid towards rent to Landlord since April 1, 2020 (including any rental assistance provided by a 3rd party)? *
ex. April $500, May $200

Hayward Rent Crisis Mediation Request

Prior Mediation?
Did you participate in Rent Crisis Mediation concerning this unit before?

Yes No
If yes, would you like to work with the same mediator?

Yes No

Hayward Rent Crisis Mediation Request

Language Assistance
7. Do you need an interpreter to have phone conversations with the mediator? *

Yes No
8. If you need interpretation help, do you have a trusted person age 18 or older who can translate for you?

Yes No
9. If you do not have a trusted person to assist you, what language do you need?
Language

Hayward Rent Crisis Mediation Request

Tenant Duty to Notify Landlord about Financial Hardship (Tenants)
Tenant must make a good faith effort to notify landlord that they cannot pay rent due to COVID-19 related issues. The City created a form tenants may use:

Notice Aviso 注意

Though not required, Tenants should be prepared to support their claim with evidence/documentation. Examples of evidence include, but is not limited to:
- a letter from an employer citing COVID-19 as a reason for reduced work hours or termination
- paycheck stubs from before/after the COVID-19 outbreak
- increase in childcare costs
- bank statements showing financial situation before/after outbreak
- application for Unemployment Insurance or Disability
- medical bills due to COVID-19 illness, that are not covered by insurance
If no documents are available, be sure to acknowledge this and explain the circumstances in the Notice you provide your landlord.
10. The eviction moratorium requires Tenants to notify their Landlord if they have financial hardship due to COVID-19 and cannot pay the full rent. As a Tenant, I am aware of this obligation and I have notified my Landlord. *

Yes No. To ensure your protection under the Emergency Ordinance, you should notify your Landlord in writing of your circumstance and can use the form linked to above.
11. If possible, please upload a copy of the notice or communication(s) you sent.

Choose Files
Scan or take a picture or screenshot of the document or communication. Then select Choose Files and locate the picture or file. Cancel of

Hayward Rent Crisis Mediation Request

Tenant Duty to Notify Landlord about Financial Hardship (Landlords/Property Managers)
11. Per the Hayward's temporary eviction moratorium, the Landlord ought to be notified if the Tenant is experiencing financial hardship due to COVID-19. Were you notified of your Tenant's financial hardship?

Yes No
13. Do you communicate with the Tenant in English and believe the Tenant speaks and understands some English? *

Yes No
14. If you answered "No" or "Other" to question 12, please explain and/or indicate which language(s) the tenant speaks.
15. If possible, please upload any notices or communications received from your tenant about the hardship they are experiencing.

Choose Files
Scan or take a picture or screenshot of the document or communication. Then select Choose Files and locate the picture or file. Cancel of
16. If you have sent any notices or letters to the Tenant regarding rent payments during COVID-19, please upload them here.

Choose Files
Scan or take a picture or screenshot of the document or communication. Then select Choose Files and locate the picture or file. Cancel of

Hayward Rent Crisis Mediation Request

Tenant and Landlord/Property Information
Tenant's Name *

First Name Last Name
Names of all other tenants on the rental agreement - if applicable
Name(s)
Tenant's email
example@example.com
Tenant Phone Number 1 *

Area Code Phone Number
Tenant Phone Number 2

Area Code Phone Number
Tenant Counsel or representative name and contact information (if applicable)
Landlord or Property Manager *

First Name Last Name
Company (if applicable)
Landlord/Property Manager Email
example@example.com
Landlord/Property Manager Phone Number (if unknown, type 111-111-1111) *

Area Code Phone Number
Landlord/Property Manager Phone Number 2

Area Code Phone Number
Landlord/Property Manager Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Landlord counsel or representative name and contact information (if applicable)

Hayward Rent Crisis Mediation Request

Other Information
What times of the day are you most likely available by phone?
Settlement terms (optional): If you wish to propose rent payment plan, you can do so here.
Things to consider - how much rent can you pay now?
Additional information/explanations:
If there's anything else you wish us to know
Additional documentation, if needed

Choose Files

Cancel of

Hayward Rent Crisis Mediation Request

Submission and Acknowledgement of Confidentiality
By submitting this request for mediation, I affirm under penalty of perjury that the information I have provided here is true and correct to the best of my knowledge. *

I agree
Did someone assist you with filing out this questionnaire? *

Yes Yes. City of Hayward Staff No
I have read the Confidentiality Acknowledgement and Agreement below and agree to its terms (a copy will be sent to you after submission).

I agree
In English: Confidentiality Acknowlegment and Agreement

En Español: CONFIDENCIALIDAD RECONOCIMIENTO Y ACUERDO
Name *

First Name Last Name
Please verify that you are human *
Should be Empty: