LRAC PKT 11-14-2012 GITY OF
e era a
CDBG LOAN REVIEW ADVISORY COMMITTEE
AGENDA
November 14; 2012 11:00 a.m.
Nyberg Room
1. Call to Order Chair Evans
2. Roll Call Catalano
3. Approval of 10/2/12 Minutes Chair Evans
4. New Business
a) Review Application Review Process Chair Evans
5. Old Business
a) Loan Review Manual handouts Bennett
b) Mock Loan Application Review Bennett/Spicer
c) Evaluate Application Review Process Chair Evans
6, Staff Reports
a) Microenterprise Symposium Bennett
b) Loan Program Marketing Bennett
7. Adjournment
CITY OF FEDERAL WAY
LOAN REVIEW ADVISORY COMMITTEE
SPECIAL MEETING SUMMARY
OCTOBER 2, 2012
COMMITTEE MEMBERS PRESENT: Graham Evans; DQnald Bartlett; Lori DeVore;
Keven Dunn; Frank Spicer; Mark Hutson. �
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COMMISSION MEMBERS ABSENT: Noa��;��f� � � f;��y.,,
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STAFF PRESENT: Ja Bennett Communi rvices ��na er; P��,�#ieckwith, Cit
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Attorney; Dee Dee Catalano, CDBG/Human Set��es.��rdinator. ��--
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GUESTS: Councilmember Susa'r��f3���poke anrr�'�,anked the Committee members
for their service and commitment to�� `' <
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CALL TO ORDER ���;'j,i`'"�'i�, rr� ,,,;�,�;;;� . `.,;�,�,
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The meeting was c to ord�'�t 11:00 ��;�.
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ROLL CA .���:.. ','r'�''',.,,�,%%f�'%,f�,��>>., ;,.
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APPRO� F 9/28/12 UTE��-;�,
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Lori DeVore d appro�,;lof the September 28, 2012 minutes. Keven Dunn
seconded the m , whi arried 5— 0.
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OLD BUSINESS ,,r;�,,,.�s
a) Reflections on City Attorney provided materials
The Committee members discussed the materials the City Attomey had presented at
the previous meeting.
b) Draft Loan Review Manual Discussion
Jay Bennett urged the Committee members to review the PowerPoint presentation he
emailed them so they better understand CDBG rules and regulations.
1
Jay Bennett reviewed Committee members' comments regarding the Commercial Loan
Review Manual. Jay will make selected changes and provide replacement pages at the
next meeting.
The Committee members recognized the differences befinreen private capital and the
use of CDBG funds for project funding and how that may constrain funding projects.
c) Loan Process Discussion
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The Committee discussed establishing processes to r.,,'! `'loan applications. Chair
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Evans asked if applicants will come before the Corr����� to make their case. Jay
Bennett replied that it is his intention that applica��e��,�t? the Committee after staff
has reviewed their application. ,�-''�, `` `���<:-�
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There was discussion about using the wir����of availability of��rf�s/review when
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advertising CDBG Commercial Loan Progr��:,This maypincrease ����cations that the
Committee can review at each of their regula ,;J,tin
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NEW BUSINESS J ��� f �
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a) Selecting a regularly sche��d rYf'���� date �-.;.r:.
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Committee membe��r��� ���.establi e � ne��ay of the first month of
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each quarter as th����ularly`� `�i�eduled � ���date. � meeting dates in 2013 are
as follows: JanuaryJ .�� ril 10,;��1y 10, O� �er 9.
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The Com '��ged t� ���cial r�i�eting on November 14th from 11:00 am
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to 1:00.��'� re�f��';��Jnoc�(c�� ,,�n aPP�i y,;
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b)� l��te on Loan ��viciri'����ent contract
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Jay Bennett i`�rted that C � unity�apital Development (CCD), the loan servicing
agent, is submif���;their pro al and he hopes to have the contract finalized soon.
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ADJOURNMENT ��;�;ff,� ����"
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The meeting adjourned at 12:28 pm.
NEXT MEETING
Special Meeting
November 14, 2012
11:00 am — 1:00 pm
Nyberg Room
2
CDBG Loan Review Advisory Committee (LRAC)
Commercial Loan Review Process
November 2012
(To be incorporated within the CDBG Loan Review Manual)
1. CDBG Loan Review Team
a) The Chair of the CDBG LR.AC shall form its members into loan application"lead"review teams. The
sole purpose of this review team is to meet with Ciry staff and one (1) representative from the City's
contracted small business technical assistance program for preliminary discussion of a CDBG Loan
Application. ,;>;�;,
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b) Community Services Manager assigns applications for C ., ' ��ding to the review teams in rotation to
be the lead reviewer on each application. `�'� '��;;-�
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c) The review team shall consider whether to inves���G resources' red by forwarding the
application to the City's contractual Loan Se ` �'�Agent. One LRAG�'�%�`" ber shall report on the
discussion and decision at the next meetin ot�'f��`'�.RAC Committee. Th�'�LRAC Committee can
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(by formal motion and vote) reverse the review te��� decisi���
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d) The review team meeting will only��5�'�,�,,}x'�?on dete � n by City staff that an application is
if.�,
complete and eligible for CDBG furic��. -� <.,.' , ,��� . ;
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e) City staff will assign applic��ons for CD�,�`funduf�''�,r��r�e re�',�ms on a rotating basis..
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� Complete and eligi}�F���'� plicari"��`:• or xevied�������f`orw����,�o,the review team five working days
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before the meeting.��`'�;'�; '�r��,'',�. �f'���
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2. LRAC Co ' �on �,.�/fjj.��`�s��.%`�f,�,:f .`�,
Discussion anSJ;' -�f actto�i,`S�`CDBU�;�.ap�tions shall (generally) adhere to the following
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protocols at ' LRAC me`"� �" ,. �'`' ; �'
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a) City sta����� ents technica�; ',lysis hC���he application conforms to criteria (5 minutes):
i. C � nce with C:,` � and 16�i requirements
ii.Lo �',,�e job creati , aintenance
ui. Curreri��ount of���:`"G Commercial Loan funds availa,ble for disbursement
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b) LRAC review team me sents analysis and team recommendation (5 minutes)
i. Strengths of the`� lication (e.g., sound financial projecrions)
u. Risks in the application (e.g.,large number of established competitors in Federal Way)
iii. Clarification on information souxce or request for additional information.
c) Presentation from the applicant (5 minutes if desired).Applicant is encouraged NOT to repeat verbatim
the content of their application.
d) City staff summarizes the comments on a board in the meeting room
I
' 3. Full LRAC Committee discussion (10 minutes) I,
Committee members add and give alternarive views as appropriate -but do not need to repeat where in
� agYeement with review team. City staff summarizes on board as appropriate.
4. Clarification (5 minutes)
Based on the summary and paxticulaxly`uncertainties' and differences of view from committee members,
applicant may be provided further time to address the committee (OR- committee members ask questions
each in turn to the applicant- for up to 10 minutes discussion).
5. Motion for Recommendation to City Council
Chair asks the lead reviewer to put the motion and for a second, and then puts the motion to a vote. Reasons
will be passed to the City Council along with the funding recommendations. (If vote is opposite to view of the
review team, one of the `Nays' summarizes the reasons).
6. If there are multiple applications reviewed and recommended, City staff summarizes the total amount of
loan monies that will be required to fund all the `recommended for funding' applications.Where this amount
exceeds available funding, Chair asks committee members to nominate the least fundable applications,with
reasons. These recommendations are also passed to City Council.
7. Outputs
LRAC outputs from the meeting to the City Council are:
a. Recommendations for CDBG Commercial applications to be funded (or not)with conditions of
funding and LR.AC reasoning.
CQMMUNITY CAPITAL DE VEL4PMENT This is nrr Equal Uppu�•tunrh�Prugram. Discrimi�ratinn i,s prohihitect
APPLICATION FOR BUSIN�SS LOAN ht'Federal LuN�. Contplaints qf di.rcriminutiv��may he.filed with 1hc
G'SD.A,Directnr, D icc°ofCiril Ri�hts, LL'ashinatnn, D.C. ?0?_50
Name of Applicant Business Employer ldentification Number or SSN
�Tane L.Doe Landscaping Service 91-66b66
FuU Street Address of Business Telephone No.(incl.area code)
1234 Any Street.Federal Way,WA 98123 ?53-123-4�67
Type of Business D�te established Faa No.(incl,are�code}
Landscape Jan 1,?0]0 253-133-4589
Cell Phone No.(incl.area code)
?53-123-6021
Legal form of Business Number oF Employees
C-Ca S-Ca Ltd.Liabilit Co Partnershi [X Sole Pro rietorshi At Nme of application 1
Do you have ownership in any cither business? If yes,please provide name and address: How many jobs wilt be create if
No loan is appraved'? �2
PUR1'OSE OF I,OAN (Describe how the loan will help you start,develop or expand yaur business.)
Purchase truck to carry landscape equipment
Please identify how the loan proceeds wi11 be used: Dollar Amotutt COLLAT'E12AL:(inc)ude current business assets,personat
Acquisition and/or repair of machinery/ec�uipment __�t5,U00 assets aad business assets to be purehased with loan proceeds)
Cantract financing Dollar Amount
Inventory purcha.se Accounts receivable
Operating Capitai F Furniture,fixtures
I,ea.sehold improvements ��` Inventory
Purchase new or existing franchise .
�� Machinery/equipment
Purehase/expandlrenovate real estate � Real estaie equity
Resu-ucture of debt Auto (Year 2012_Make._Ford Van____) _520,000,
TOTAL LUAIti REQUESTED � $t g,�pp Other: _
Your requested length of repsyment is:� 3 years ^_^ Other: Y
TOTAL $2U,000
OWNER INFORMAI`ION Date Sncial Security � %of
Name and Tit1e of Birth Nmnber AdcEress Phone# Ownetshi
Jane L.Doe 06/18/(ii3 123-45-6'789 1234 Any Street,Federal�lvay,WA 253-123-4567 100°io
' Attach a separate shett for an�•additional owners. Total Ownersh� 100%
a. Has the Applicant or any Owner of tkie company ever been convicted, charged with or arrested for any criminal offense other
than a minor motor vehicle vioiation? Yes No X If yes, furnish details in a separate exhibit.
b. Is the Appiicant ar any Owner a party ta a claim or Iawsuit? Yes No X If yes, furnish details in a separa.te exhibit.
c. Are any business assets currently pled�ed as collateral? Yes No X_If yes, furnish details in a separate e�thibit.
d. Has the Applicant or any Owner ever declared bankruptcy? Yes_No_X�If yes, furnish details in a separate exhibit.
AGREEMENT/SIGNATURE(S)
The app�icant certifies that all information provided in conjunction with this application for credit is complete,true and correct
and authorizes Cammunity Capita.l Development to obtain credit reports on the Applicant, Owner(s)and any Guarantor,if
required. If appmved far a loan,all parties agree to compiy with the terms and conditians of the loan documents. Each person
signing below certifies they are authorized to do so.
A��d�su.�mission reqt�est c�oes not guarantee an appraved loan.
�... .�!t',;zZz!,���;:� �--�- �'�'+c-�� �-� �':�`" � G� �f`'` r�.-
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At��thorized Signature Printed Name and Titie Date
Authorized.Sian�ture Printed Name and Title Date
COMMUNITY CAPITAL DEVELOPMENT Credit Commitment Report Page � of 1
BpRROWER#1: Jane L.Doe Landscaping Service LOAN NUMBEf2:
Primary Contaet: Jane L.Doe Credit Score: 7?5 �
Taxpayer tD: Legai Form: Sole +9vnership Risk Rating: High
Address: 1234 Any Street. �ederal Way NAICS Cade: 24579 _gg__Average
City,State,Zip: WA 98123 Bus.Start Date• _zgn 20l(I Low
Phone: (Ce1f) 253-423-6021 Fax: 253-123-4589 Bus. Gross Anl. Receipt:
GUARANTOR#1: Spouse Name: No Spouse
Name: Credit Score: Spouse SS:
Taxpayer fD: "�`—""Credit Score:
Address: Personal lncome:
City,State,Zip: Celh LMt: Yes No X
GUARANTOR#2: Spouse Name:
Name: Credit Score: Spouse SS:
Taxpayer iD: ��Credit Score:
Address: Personai Income:
City,Sta#e,Zip: Phone: LMt: Yes Nc X
7YPE f?F BUSiNESS: LOCATION: OWNERSHIP:
fndustriaf/Manufacturing (I) � Central District(OQ1� Minority Yes No x
Commercia(/Retaif(C) � internationat District{002j Ethnicity �
x Service(S} _ Southeast Seattle(0�3) Woman Yes No
_ Duwamish (004j Ownership� '
PROJECT W{L�ENABLE BUSENESS TO: x Other(005) Federa}Way
Start-Up � Veteran: Yes No x
x Expand dOS5: Vietnam Era
Sustain 1 Existing�Retained
2 Crsateci in next two(2}years CCR REQUEST:
3 Total Mew Appiication
Modificatian
PURPOSE OF CREDIT REQUEST:
To purchase Ford Van to carry Landscape eguipment
Term(Manths): 36 Months = TBD interest anly(Mos) TBD Fuily Amortized
Loan Amount: $15,000.00 Rate�: TBD Type af Loan: Term Revofving
Prior Loan(sj: $0.00 CCD Laan Feez: $100.00 Location: Rural
TotaE Outstanding: $OAO S8A Fee`: N/A Urban X
Other Closing Fees`:
_ - xe , - ar ab e - nance , - a in as
TECHNiCAL ASSfSTANCE:
Number of hours: Peer Group Ciassroom 1 8iz Plan 3 Other 1
Site Visits 1 One-on-On� 3 Rel.tssues
A : e o. o an ar
DOT Com'i/Res Lien: � Grantor: N/A
UCC-1 AR 1!nv l Eapt Lien: 1 Debtor: N/A
lJCC-2 Fixfure Lien: 1 Debtor: N/A
X Titled Vehicle Lien: 1 Owner: N/A
Other L.ien: 1 Grantor/Debtor:
BANK INFORMATION: Participation? Yes No X
Bank of Account: TBD Participating Bank: N/A �
Accoant Number: TBD Bank Loan Amt: N/A–""
Automatic Payment: Yes X No
Loan Conditions:
Customer must put$5,Q00 down payment plus tax and ficense
Lo, yOfficer: Date: Chief of Staff� �Date: C p - D .�.� �`�� _ � .,�� � -
,` � ;' 4� /'�'1�...._
,� � ��K„�-� Jim `rr�s�'"�`` ....
uersbn 04-24-ZOQ7 ''
COMMUNITY CAPITAL DEVELOPMENT
LOAN WRITE-UP
Submitted By: Reviewed By:
I Am Lender Joe 5mith,Chief Credit Officer- ]0/10/12
Loan Ufficer Date Name ��W � u Date '
Applicant:Jane L. Doe
Address: 1234 Any Street, Federal Wa,y,WA 981111
Taxpayer ID#: 123-45-b789
Guarantor: None
Address:
SSN:
Eli 'bili : Low income woman awned business in Ci •of Federal Wa
Purpase: To partially finance 75% of a truck purchase used to haul la�ndscape
equipment.
Amount Use of Funds Source of Funds
$ S,OUO Down Payment on Vehicle Owners Investment
I5.000 Finance Residual Payment CDBG Federal Way
$2U,000 Totat
Fee: 2%
Rate: TBD
Terms:36 manths
Collateral: 2012 Used Ford Van that originai sald for$32,000 with 1Q,000 mites
Sources of
Repa,ytnen#: Primary source of repayment is cash flow from business. .
Secondary source of repayment is liquidation of Ford Van.
Tertiary source ofrepayment is residual claims to applicant.
ProposaE: To prov'rde CDBG micro financing to parchase ased vehicle.
Business Description: .iane Doe Landscaping was started in January 2010. Ms. Doe
decided to use the kxiowledge that she had.learned about landscaping when she worked .
for the Parks Department frozn 2005 thraugh 2U()8 when she was laid off. She has built
COMMUNITY CAPITAL DEVELOPMENT
LUAN WRITE-UP
the business up to the point where she now earns $4,OU0 a month for herself after paying
her support people and related business expenses.
Ms. Doe has a Letter of Reference from her former supervisor at the Parks Depariment
indicating she was a good employee and was laid off due to budget cuts and not for jnb
performance.
MSIIBgement:
Jan Doe manages her compamy with the support of an outside bookkeeper. She has
presented 1040 Tax returns for the years 2Q 10 and 201 l. Her business taxes were
presented on form`'Schedule C'`of her personal tax returns.
Comnetition and Market:
The competition and market for landscaping residential properties is strong in the City of
Federa7 Way. Most business,according to Ms. Doe comes fro�n word of mouth
advertisin�at�d from referral from satisfied custorners. Competition is strong because the
initial investment to start a landscaping company is limited and does not require a
significant cash investment outlay by the business owner.
Ms. Doe has in addition to her residential contract (these axe month to month) signetl
annual con�racts to handle the landscaping far her church and for a locat natianal fast
food francl�ise. These annual contracts give her a faundation a�id a c:ompetitive
advanta�e in the market place as she builds her business in the Cit.y of Federai Way.
Financial Management Skills:
Ms. Doe uses Quick Baoks for her in-house accounting and an outside bookkeeper to
handie taxes and payroll matters. It appears she has the financial skills to manage her
bnsiaess.
Financial Analvsis:
Financial information foz Jane Dae Landscaping Company is reflected below.
Jane Doe Landscaping �ompany
Income Statement Su.mmary for Years Ended 12/31:
Proiections
2010 2011 2012
Net Sales $69,243 $145,410 �175,400
Cost of S�les �S1,239 $1U8,330 $130,357
COMM�JNITY CAPITAL DEVELOPMENT
L4AN �VRITE-UP
General d:Acfministrative $2�,?34 �3?,717 $39,�75
Pro£rt before Tax $"7'70 $4,363 $5,?50
Tax $61� �I,047 $1,260
Net Profit $2,160 $3,316 $3,490
Coilateral and Secondarv Cauacitv:
The collateral for this$15,000 will be a clear title to the vehicle. The dealer has indicated
that this vehicIe was returned due to the previous owner upgrading to a Iarger�ehicle.
He has offered Ms. Doe the rernaining 32 months warranty on the vehicle without charge.
Personal Financial Stren ths and Credit Histo �:
Ms. Doe has a credit score of 725 and her credit report reflects the following;
Public Record—0 Collecfions,Negative— I (past due medical bill that was paid in full,
Tra.des - 5,Revolving— 1, Instailments— l, lnquiries—2 (�ast two years).
Terms and Conc3itions:
• Far the f�rst six nnonths,monthly company prepared income statements to be
provided and reviewec# with a Business Assistance Officer within?0 days of month
end.
• Quarterly company prepared financial stateinents, within 6t)days of period end.
• Annual professionally prepared business fmancial statements,within 120 days of
period end.
• Evidence of general liability insurance on business,replacement insurance on
business Van and other equipment.
Summarv and Reeommendations:
Strengths:
• Management and industry experience
• Historical profitable cash flow of the business
• Business is a going concern
• Reasonab}e secondaiy source of repayment
COMMUNITY CAPITAL DEVELOPMENT
LOAN WRITE-UP
Weaknesses:
• Low personat liquidity
• Lack af additional collateral
• Lack of management secession
Recamnc�endation:
It is recommended tkxat this toan be a}�proved as presented in canjuncrian based on the
historical performance of the business,the management and professianal experience of
the owner, and the secondary source of repayment.
COMMUNITY CAPITAL DEVELUPMENT
LfJAN WRITE-UP
FOR CFW CDBG LOAN
CDBG NECESSARY AND APPROPRI.A?E
1. Is T�ere A Demonstrated Ga ?
The loan request cannot be supported without the CDBG econamic develapment Assistance due
to the foElowing:
*MS Doe has been deciined by 2 banks.
2. Are The Costs Reasonable?
*Use of proceeds have been reviewed ry Community Capital Development Loan Officer and are
considered reasonable.
3. What Is The National 4bjective�
*The na#ional objective is job creati�n. One new job will be created with this loan.l'he created
j�b will henefit a iow to moderate income person and provide a long-terni employment
opportunity.
Household Incame Summar,y llpdatedJanuary20i2
Community Capital Development ha�certain information-gathering requiremcnts that it must fulfill to continue receivin�
funding to provide you with husines�trainin�and counseling services. The it�formation in the foltowing farm is re}�orted
a�staristics,not individual data.The information you pro�c�ide w�ll remain confidential and wil!onl��fic shcrre.d,a�ith ahe
Citv to cr,rr irm compliunce f>r CDBG eliYdhilitv. We keep this farm on file ta document that we are sening our intendect
client base.
Date: 10� 1Q�t2 Email: Saned�i;gmaii.com ___�__
Last Name: Doe Middie Initial: L First Name: Jane
Address: 1234
Street
Fe3eral WaY WA981?3 '?53-123-4567
City Zip Code Phone Number
Male: ❑ Female: � Head of Household: Yes❑ No❑
Cbeck one box below:{o�t;on�i�
❑ White
Hispanic&Whi.te ❑ Native Hawaiian/Other Pacific Islander
Amer.Indian/Alaskan Native ❑ Amer.Ind./Alaska Native�Biack/African American
❑ Black/African American ❑ American Indian�Native American
❑ Hispanic&,Blacic ❑ Asian&White
❑ ,Amer.Indian/Alaskan Nat.�.White ❑ Btack!African American K White Islander
❑ Asian ❑ ImmigrantlRefugee
❑ Other Multi Raciat
HOUSEAOLD SIZE{please circle ane)For example:If your household size is 3,circie 3 and in the
colurnn beiow your household size,circie vour household income level based on 20IT income:
:.....:: . ::........ -- - -
>.:=:1 <. -2_,_.,.'.:;;s;`-__:::.• . _ _ ....� , .:�:::...::.:. _
_. .. �� ' - - ::�.� -
... ._:
_ . .:::.....: ...
-. : , .. ..:. _,::' _ -
; :.r:::, :
_.. ..:::
� t&.�00 $ 21,]54 $ 23,80U $ 26,400 $ 28.550 $ 30.650 $ 32,750 $ 34,85Q
or helow or below or below or below or belo�� or below OT beJOW or belau�
$ 30,&00 $ 35,200 j�9,600 � 44,000 $ 47,550 $ S1.OSQ $ 54,60Q $ 58,104
or below or below t or be or belov�� ar below or below or below or beiow
$ 45,550 � 52,000 $ 58,500 $ 65,000 $ 70200 � 75,400 $ 8U,6p0 $ 85,800
�r below or helow• or below or below or below or below or below or below
$ 45.SSU $ 52,OU0 g 58,500 $ 65,040 $ 7U.200 $ 75,400 $ 80,6U0 � 85,80Q
or above or above pC S�fOVC or above or above or above or above or ahove
This Incotne can be veri�ed bv: ` ederal Income Tax ReturnsJ W2s[]Pay Stubs/Other income Stubs Q SSI
Certificatlon&AQreement:
I certify that the total income of all mcmbers of rny household f'or 201 l is as indicated above.
'Fhis infonnztion witl be used to ensure eomplianfie-�i�Xh the U.S.Dc�►�rtment�f Hausiag and Urban DevrJc�pmenk
Community Development Block Grant requi ents. t`understand this may be monitored and that 1 may be asked to pmvide
sc�urce documentation. With my signfltur�, am c;erti�ying that the o flnarion is cc�rrect,to the besY of my knowled�e.
Jane L.Doe f f, •�' ��a (°` i �
Print Name Signature Date
Lt is the�x�licy of our organization to provide equal crpportunity to at3 applicants for our services and to ensure that there is no
discrimination against any prrsons on the graunds af race.calor.natiana!origin,}xilitica!affiliation,sexual preference.age,or
sex. The following qu�tion reg�rdin�race/ethnicity is for the purpose af trackin�the benefits of our services,is�tional,and
wi}f remain eonfidencia3.
OFFICE USE Oi�tLY C�Iient ID#t:
�::=::j`.,jM.I '._:--::_:_:--=_=__.,-M_=_.—_:._T:.—_�_._—��_..._,—_,_.:--�_._..___--:_:-_-�-_-.--=._---:�.EXPIRATIONDATE.09/30/2Q148� ji
�! OMB A PROVA NO 3245-01&
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< . _ PE12SONA�F[NAN TATEM
(� �'.,.';.,� � 1fl11D 2012 ii
U.S.SMALL BUSINESS ADMlNISTRATION �of �
Complese this torm for:(I)each proprietor;(2)getieral pattner;(3)managing msmber of a limited Ilability company(LLC);(4)each owner of 20°k or trsore of
the equity of the Applicant(including the assets of the owner's spouse and any minor children);and(5)art�,persnn providing a guaranty on the loan.$�
&pmnieted fnrm�p;7(a)loans-to the lender processing the S8A applicatfon;SD4 loans-to the GertiBed Development Company processing the SBA
appiication;t�isas#er loans-to the Disas#er Processing and Disbursement Center a#14925 Kingsport Road,Fort Worth,TX 76t 55-Z243;and 8(a)!BO
appfirants who are individuals ctaimirrg socia!and economrc disadvantaged status and their spouses-eiectranicaliy af htto:/lwww.sba.flov or send hard�
copy with paper apalicatian to either of the two following offices:
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Name Jane L.Doe ��� � Business Phone 253-123-6021
Residence Address 1234 Any Str�et,Federat Way Residence Phone 253-123-4567
City,State,8 Zip Code WA 98123 -"�'.`_—____..___—,.._._.._.._ �,�_.._._..
Business Name of Applicant/Sorrower LandsCeping SBt'vice T� ' `
� LIk81Ll'TiES
----------- ASSE7S (Omit Cents) I------ {Amit Cerits) -
__ ___.. - --
Cashonhand&inBanks ..••-••---------- 56.fl��--•--,---�AccountsPayable------•-...-••••-••--..... SO
Savings Accounts $fl.----_.._._—_._,.�Notes Payatrle to Banks and Others...---.....- $�_----_----,
1RA or Qther Retirement Account..,_ $47 000.00
----•- - (Oescribe in Section 2)
. .,---
(Rescribe in Section 5) I{nstaBment Account{Auto}.__, __..__ $�.
AccouMS 8 NoTes Receivable------•••--... $0 _._----,��_ _i Mo.Payments $ ...'-----
(Describe in Section 51 ` Insfallmem Account{Olher)_ � _... g d
Life lnsurance-Cash Surrender Value Only__.. $d ! --•••-••-•••--
""'--l�""""-�` Mo.Pa ments
(Complete Section 8) ; Y 5___._—_____
Sto�ksand8onds......_._..�.__._.__.. $d_ __ IloanonLifelnsurance...................... aa
(Describe in Section 3) 0 ;Moftgages on Real Estaie.................... ��_—
Real Estate---•••••................... �---._..__. _�_,f (Describe in Section 4)
(Gescribe in Section 4) �
IUnpafd Taxas.-•...............•....••---- $._.
Automabiles-Totat Present Vafue $2�����fl {Oesaibe in Section 6}
(Describe in Section 5,and incfuiie '�"� 4 � pther Liabilitfes___________________________ $�
YeadMake/Modef)
Other Personai Property.---•-•--..___.__ S�_.._. � (�scribe in Section'n �
(Describe in Section 5) - 'Total Liabillties-----•-••--._.....�._._..._. �.—
Other Assets __ �� � �t�et Worth ----...---•----...... .. $55,000
...---..
� ---•---�---.'- Total g 55.0OO.OQ _ Totpi S 55,Od0
Desaibe in Section 6 F�_ -I �'
Seciion 1. Source of Income CorKi�gent l.tabilltfes
5aiary. ............. 3 4.fl�0/Month I 0
_..._......•-•... —,.._�--------- As Endorser or Co-Maker.---•............... $
Net InveatmeM Income g 0 $0
I Legal C{a�ms&Judgments_.__.___.
••-•....__..••-••-• -
Real Estate lncome S �___�____�_� provision for Federal Incame Tax $�
-•-•--•--•••-----••-- � � .......----•-..
Othe•income(Descnbe beiowY ..-•----••• 5__--�.� ,__.;Other Speciai Debt•---•••••-•....... ...... $0
Description of Other income in Section t.
—_..��._.__...--- __....�___...__.___._.------_,..____.____ �.... ___....
'Allmon or chUd su rt pa mems need not he disclosed in"Othet Income"urdess ff is tlesi2d to have such pavmeMS countetl taward total income.
SBA Form 413(08-111 Previous Editions 06solete �
Seetion 2.Motes Peyable to 8anks and Others. (Use attachments if necessary.Each attachmen{must be fdenftfied as a part of this statemenf and signed.)
Name and Address of Nateholder(s) 4riginal l, Cuttent ; Payment Fre uency How Secured or Endorsed
� ___ �_ Bafance Safance ; Amount (mont�ly.etc.) __ Type ot Colkataral
� ---r--�. --�--�-- �
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---- _. _�__..._-- ' ----.-�__..__-;�__ i __._.--.i- - -_..._�_
' ------- ----� I
----------- � -,---�._.__�-..�- ----
_�._�..--- i �.
_..-------_ .._.__._ _.____.._..----_..�____ ___._ '
- - .__�__.__------ ------_...-
�_---- --_.�.__.�_..�
_..._._ _-------1-------�-----_ ! _._._�. �.� _- --
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i Seetian 3. Stocks and Bonds.(Use aifachmeMS!f necessary. Esch attachment must 6e identiHed as a part of this statemeM an6 sign�d�.
Market Value Date of '�
' Number of Shares' 1Vame of Securities ^ Cost u' � � Totai Vaiue
QuotafionlExchan e,QuotationlExchan�e�
j N/A -��
+ .�_�---_..._ _._. ._ .�- ;
____._.-- ___.. �_
i ; -ti--------- -
------- ------__�.�._
� _.._.� �__._.___ .
.______._.. -- ----- I ..-
--- � -------f ---�--- - __�_ ._.�.-.
Seetion 4.Real Estate OwneB. (List each parcel.separately..Use attachment-if neoessary.Each attachment must be iden6fied as a part of this
statemeM and.signed.) •
� Property A -- ;. Property$ � Proper#y C
Type af Real Estaie{e.g.Prima,ry �-"
,'Residertc2,Other Residsnce,Rentsl
IproPeKY,�and,etc.) .__ _.._.---�..__. � ._._�W_.._ __._ _ .
�I Adtlress .. - �
. � --- -_.- ` __�.-__-____�
�'DaYe Purchased � ___._�._.----------
� - --�- - ------�_�_��. .M_ - -�..
._____
Original Cost . I
� i--- ----�....._.- _•_.----�..^_._ -____�- �_..___-----•- ------
�Present Maricet Vaiue � _�._�-- -- -------- -_. ___�._ __.._---
;Name& I �
AddFess of Martpage Holder : j � �
1 ��.�-
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Mort,gage Account tdumber, _ �
� _.._� .�__ ,___ _---_
�Mortgage Balance i � _��,- -- _'_`�__ � �
AmounYbf Payment per Month! _-�
Year . . _.. _._--- ------, _ + -----
Siatus ot Mortgage - i �
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�Settion b.O�ther Persoftel PropeTty and OEher Assets. (Deecribc,and�if eny is pbdped es seeutrty,state name and addrcss at Iren hdder,amount of i�n,terms
W a me�t and'rf dep ueM,descrlbe=dehnauancyl
+(�'�year o o swage`n�e a f�va ue o , �
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5ectian 6._ Unpaid.Taxes. ' {Describe in detail,as to type,to.whom payable..when due,amount,snd to what property,'rf any,a fax iien attaches.) �
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; Secrion 7. Other Liabiilties. (Describe in detail.)
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SSk Form a13(08-19�Previous Edkions Obsalete 2
I�r8ection 8. Life lnserance Held. --��--'�"---- --._._..__...---...---- ---,--- --_..--- '
_�_ _ (Give face amounf and cash surrender value of_policies-name of insurance company and beneficiaries) �,
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�i• I authotize SBA/Lender to make inquiries as necessary to verify the accuracy of the statemsnts made and to determine my creditworthiness. �
CER7JFiCATtS'� (to be completed by each person submiiting the information requested on fhis form)
��
�� By signing this faan,{ceRify under penaky of criminai prosecution that ali information on this 4orm and any additional supporting infoRnation submitted
with this form is true and,comp�iete to the best of my knowiedge. 1 understand that S$A or ifs participating Lenders,or Certified DeveEopment Companies
Iw'rfl rely on this info atiort when makina decisions regarding an appiication f�r a loan from SBA or an SBA Participating Lender,or for paficipation in '
the SBA 8(a)B ness Development{Bpj rogrart�=-... i
� � 1Q/10/12
� Signaturs ������ E 1 7"-"�',,,.. Date
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` f Jane L. Doe 123-45-6789
Prini Name Social Security No.
Signature bate
Print Name Social Security No.
l+IOTICE TO LOAN APPLICANTS:CR1MiNAL PENALTlES AND ADM1NlS'fRATIVE REMEDIES FOR�ALSE STATEMENTS:
�
�� Knowingfy making a false statement an this form is a violation of Federal law and could result in criminal prosecuiion,sign�cant civii penalties,snd a
� denial of your}oan.A false skatement is punishable under 18 U.S.C.§§106 i and 3571 by imprisonment of no#more than five years andlor a flne o#up to jj
j $254,000;under 15 U.S.C.§645 by imprisonment of not more than two years andlar a fine of not more than�5.000;and,i�submitted to a Federeliy ry
! insured institutian,a false statement is punishable under 18 U.S.0 §1Q14 by imprisonment of nol more than 30 years andJor a fine of not more than �
$1,004.000.
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� NOTIGE T8 APPLtCANTS OR PARTICIPANYS IN THE 8lal BD PROGRap�;CRIH{iNAL PENALTIES AND AAMlNlSTRATIVE REMEDIES FOR
� FALSE STATEMENTS:
��II Any person who misrepresents a lwsiness concern's status as an 8(a)Program participant or SDB concem,or makes any othsr false statement in order
to inffuenoe the 6(a)ceR�cation or other review pmcess in any way(e.g.,annua!review,eligibility review),-shal!be:{9}Subject to fines and imprisonment
I� of up ia 5 years:or both,as stated in 7itle 18 U.S.C.§1001;(2)subject to fines ot up to S5DR,000 ar imprisonment oi up to 1�years,or both,as stated itt
� TiUe 15 U.S.C.§645;(3)Subje�t to civil and administrative remedies,including suspension and debarment;and(4)ineiigihle far partieipatian in �
�� programs conducted under the authority of Yhe Sma[I Business Act.
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PLEASE NOTE: TMe esdmated average burden fiou!s for the rnmp4e0on of thls iorm is 1.5 nours oer respo�se.!f you have questions or camments
conceming thts esamate or any oiher aspeet ot this information,please contact Chief,AdminisVaqve Branch,U.S.Smal3 Business
Administratien,Washinpron,p.C.20a-l6,and Cfearance Officer,Naper Reduction Pro�ect(3245-Oteey,Ofrce of t�lanagement and Budget,
Washington,D.C.2Q503.FLEqSE DO NOT SEND FORMy Tfl OMH.
SBA�orm 413(OS-11)Previous EdiEions 06sofete 3