1010B-CDC 8(a) Community Development Corporation-Owned Concern

OMB Approval No. 3245-0331
Expiration Date: 08/31/07

8(a) Business Development (BD) Program Application
Community Development Corporation-Owned Concern
To Be Completed by SBA
Date Received
CTS Number

Business Information
1.

Name of Parent Community Development Corporation (CDC)
The CDC is a nonprofit organization responsible to residents of the area it serves which has received financial assistance under 42 U.S.C.
9805 et seq.

2.

Address of Parent CDC

City

County
3.

State

Zip Code

Business Name of Applicant Concern (include any trade or d.b.a. names)*
* The business must be for profit.

4.

Street Address for Business

City

County
5.

State

Zip Code

Mailing Address (if different from above)

Telephone (Area Code/#):
Fax Number (Area Code/#):

6.

Type of Business:

7.

IRS Employer's ID Number

8.

Primary SIC Code*

Manufacturing
Professional Service
Franchise

Retail Dealer
Non-Professional Service
Wholesaler
Number of Employees

Construction
Concession

Date Established
% of Revenues

*The primary Standard Industrial Classification (SIC) code should represent the largest portion of sales from the most recently
completed fiscal year.
9.

PRO-Net User ID#, If applicable:

10.

Is the firm located in a HUBZONE Area?

11.

Is the applicant concern certified as a Disadvantaged Business Enterprise (BDE) by a Department of
Transportation recipient?

Yes

No

Don't Know

If yes, identify State(s) and ID Number(s):
12.

Do you have any other certification as a disadvantaged business entity, i.e., MBE, DBE, WBE, etc.?
If yes, by which state or localities?

SBA Form 1010B - CDC (8-04)

This form was electronically produced by Elite Federal Forms, Inc.

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Ownership and Management Information
13.

The applicant concern is:

Corporation

Partnership

Limited Liability Company

FOR CORPORATIONS ONLY:
No. of Shares Authorized by Articles of Incorporation:

No. of Shares Issued:

No. of Directors authorized by Articles of Incorporation; by-laws; or by amendment to the by-laws:
14.

List Owners, Directors, Officers, Partners, Members and/or Designated Managers.
Director Officer?

Partner or
Member?

Designated
Manager?

U.S.
Citizen?

Mr./Ms.

Yes

No

Yes

No

Yes

No

Yes

No

Mr./Ms.

Yes

No

Yes

No

Yes

No

Yes

No

Mr./Ms.

Yes

No

Yes

No

Yes

No

Yes

No

Mr./Ms.

Yes

No

Yes

No

Yes

No

Yes

No

Mr./Ms.

Yes

No

Yes

No

Yes

No

Yes

No

Name and Title:

% Owned

[Circle]

FOR ALL CONCERNS:
15.

Does the applicant concern hold, in aggregate, more than a 20 percent equity ownership interest in an existing 8(a)
BD concern? Yes
No
. If yes, provide the following information: business name, address, and
percentage of ownership. Mark as Attachment 15A.

16.

Does the applicant concern or any nondisadvantaged individual, in aggregate with all immediate family members,
or non-participant concern listed above own, a) more than a 10 percent interest in an existing 8(a) BD concern in
the developmental stage; or b) more than a 20 percent interest in an existing 8(a) BD concern in the transitional
stage? Yes
No
. If yes, provide the following information: name, title, business name and address of
other 8(a) BD concern, percentage of ownership, and whether the firm is in the developmental or
transitional stage. Mark as Attachment 16A.

17.

Does another concern in the same or similar line of business as the applicant firm own at least 10 percent of the
applicant concern? Yes
No
. If yes, provide the following information: company name, business
address, affiliation with the applicant firm and percentage of ownership. Also, indicate if the firm is a
former 8(a) BD program participant. Mark as Attachment 17A.

18.

Does the designated manager devote full-time to the day-to-day management of the applicant concern? Yes
If yes, provide a detailed description of the individual's previous management experience and hours
devoted to the day-to-day operations of the firm. If no, provide details as to the extent of outside employment
or other business dealings to include daily hours of employment, location and explanation as to how this
outside employment does not conflict with the designated manager's ability to manage and control the daily
operations of the applicant concern. Mark as Attachment 18A.

19.

Does any outside entity or individual(s), other than the CDC, provide financial or bonding support, licenses or
required professional certification to the applicant concern? Yes
No
. If yes, provide the name of the entity
or individual, the nature of assistance (in the case of licenses and professional certifications, include the type
of license and/or certification) and copies of any existing agreements governing that relationship. Mark as
Attachment 19A.

No

.

SBA Form 1010B - CDC (8-04)

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20.

Does the applicant concern buy from, sell or use the services or facilities of any other concern in which any
individual listed above has a financial or any other interest? Yes
No
. If yes, provide the following
information: name, title, business name, and type of interest. Mark as Attachment 20A.

21.

Has the applicant concern or any person listed above currently or previously participated in the 8(a) BD program?
Yes
No
. If yes, provide the following information: business name of the previous Participant in the
8(a) BD program, individual name, title, address of previous Participant, dates of participation in the 8(a)
BD program an SBA servicing office of record. Mark as Attachment 21A.

22.

Has the applicant concern or any person listed above, including their spouse or any other immediate family
member, ever been an owner, stockholder or guarantor for a concern which has received an SBA loan? Yes
If yes, provide the following information: name, business name, date approved, current status, and SBA
office of record. Mark as Attachment 22A.

No

23.

Does the applicant concern, not including any other firms owned by the parent CDC, have any subsidiaries or
affiliates (see 13 CFR 121§103) or is it a subsidiary or affiliate of another concern?
Yes
No
. If yes, provide
the following information: name and address of subsidiary and/or affiliate and an explanation of the existing
relationship. Mark as Attachment 23A.

24.

Is the applicant concern, any person listed above, or another person, such as key employees with significant
authority over the concern, involved in any present or pending lawsuits? Yes
No
. If yes, provide the
following information: name of the individual, details of the suit, including current status, and provide a
copy of any available documents. Mark as Attachment 24A.

25.

Has the applicant concern filed for bankruptcy or insolvency proceedings in the past seven years? Yes
No
If yes, provide details and a copy of the bankruptcy court's final dispensation. Mark as Attachment 25A.

26.

Is the applicant concern, or any person listed above (or their spouse), or any immediate family member debarred,
suspended, voluntarily excluded or otherwise ineligible for procurement or non-procurement purposes from any
department or agency of the Federal Government? Yes
No
. If yes, please provide a list of such individuals
identifying their names and positions with said organization. Mark as Attachment 26A.

27.

Does the CDC own 51% or more of another firm which, either at the time of application or with the previous
two years, has been operating in the 8(a) program? Yes
No
. If yes, identify the firm(s) and such
firm's primary SIC code. Mark as Attachment 27A.

.

.

When submitting your application, please provide the original application, including all original SBA and IRS Forms, and a copy of
the items listed in the "Checklist of Required 8(a) BD Program Application Documents." All complete applications will be
processed; incomplete applications will be returned.

SBA Form 1010B - CDC (8-04)

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FOR CORPORATIONS ONLY:
Corporate Seal (if required by state):

President's Signature

Date

Attest By: Corporate Secretary's Signature

Date

By:

FOR ALL CONCERNS (corporations, partnerships and limited liability companies):
All officers, directors, partners, members and designated managers must sign below.
By:

Date

By:

Date

By:

Date

By:

Date

By:

Date

By:

Date

By:

Date

PLEASE NOTE: The estimated burden for completing this form is 5 Hours per response. You are not required to
respond to any collection of information unless it displays a currently valid OMB approval number. Comments on
the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., S.W., Washington D.C.
20416 and Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive
Office Building, Room 10202, Washington, D.C. 20503. OMB Approval (3245-0015). PLEASE DO NOT SEND
FORMS TO OMB.

The questions on the attached form were abstracted from the previous SBA Form 1010B OMB #3245-0015.

SBA Form 1010B - CDC (8-04)

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CHECKLIST OF REQUIRED 8(a) BD PROGRAM APPLICATION DOCUMENTS FOR
COMMUNITY DEVELOPMENT CORPORATION-OWNED CONCERN

Please provide all of the following documents in the order that they are listed and check if attached. NOTE "N/A"
IF NOT APPLICABLE.
PERSONAL ELIGIBILITY
SBA Form 413, Personal Financial Statement - Provide for all designated managers and his/her spouse, splitting all
assets and liabilities as appropriate.
SBA Form 912, Statement of Personal History - Provide for all directors, officers, members of the governing board or
business committee of the concern, designated managers, and any other person, including a hired manager, who has
authority to speak for and commit the concern. (Form FD-258, Fingerprint Card, required for affirmative answers to
questions 6, 7, and 8).
If applicable, signed copies of individual Federal income tax returns filed for the past two years, including all W-2
forms and all schedules and attachments. Provide for designated managers. Please provide signed and dated IRS Form
4506, Request for Copy of Transcripts of Tax Form.
A resume of the education, technical training and business and employment experience, including employer's name,
dates of employment, nature of employment for general managers, officers, designated managers, and key employees
(please account for all time).
If members of the management team, business committee members, officers, and directors are currently employed
outside the applicant concern, provide information on this employment and evidence that the activity does not conflict
with the day-to-day management of the applicant concern. Please indicate the number of hours per week and the
normal working hours of the outside employment.
BUSINESS ELIGIBILITY
For corporations only:
Copy of Articles of Incorporation as filed with the state.
Copy of all governing documents, such as the tribe's constitution or business charter.
Copies of all minutes of shareholders meeting electing board of directors and minutes of last shareholders meeting.
Copies of all minutes of board of directors meetings and all resolutions of the board of directors, including a copy of
the resolution to seek 8(a) BD certification.
Copies of all stock certificates (front and back) and stock register.
Copy of the current Certificate of Good Standing from state where concern is incorporated. If concern conducts
business in a state other than where it was incorporated, a copy of the filing as a Foreign Corporation and a current
Certificate of Good Standing from that state are required as well.

SBA Form 1010B - CDC (8-04)

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BUSINESS ELIGIBILITY (continued)
For partnerships only:
Copy of Partnership Agreement.
For limited liability companies only:
Copy of Operating Agreement.
Copy of Articles of Organization as filed with the state.
Other business eligibility documents - for all concerns:
Copies of buy/sell agreements, conditions precedent, conditions subsequent, executory agreements, voting trusts,
shareholder agreements or other similar arrangements which may impact the unconditional ownership of the
disadvantaged individuals.
Copies of current business insurance declaration pages (e.g. comprehensive, liability, worker's compensation, etc.).

Copies of franchise or trust agreements.
A brief description and history of the business.
Current business license (city, county, or state, as required by law).
Copies of any special licenses (e.g. public accountancy, engineering, architectural, contractor, etc.).
Copy of any distributorship, licensing or franchise agreement.
Copy of current lease agreement(s) and/or proof of ownership for all business facilities.
Copy of current lease agreement(s) for equipment, if applicable.
Copies of all loan agreements, including lines of credit.
Copies of signature cards for all business bank accounts.
Copies of all management and joint venture agreements, indemnity agreements and consulting agreements, including
agreements for assistance in completing this 8(a) BD application.
Provide a list of contracts held with the Federal government. Include award date, agency name, description of work
and dollar value.
SBA Form 1623, Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
A list of all affiliates and subsidiaries. The list should identify the name and address of the affiliate and/or subsidiary,
the type of business, and the names of the affiliate/subsidiary's owners, directors and officers.
If bonding is required by your industry, such as construction, a statement of the bonding limit from a surety company,
specifying single job limit and aggregate limit.
SBA Form 1010B - CDC (8-04)

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FINANCIAL DATA
If there are tax liens, unsatisfied judgements, or lawsuits involving the concern or individuals involved in the applicant
concern as directors, general managers, and officers, evidence of repayment arrangement, proof of compliance with
repayment arrangements, and latest status of lawsuits are required.
A current balance sheet and profit and loss statement, including an aging of accounts for the concern no older than 90
days from the filing date of this application, signed, certified and dated by the concern's highest managing individual, if
a corporation, usually CEO.
A balance sheet and profit and loss statement for each of the three preceding fiscal year-end periods, signed,
certified and dated by the concern's highest individual managing individual, if a corporation, usually CEO.

Signed copies of business Federal tax returns, including all schedules, filed for the past three years, if applicable.

Signed copies of financial statements and Federal tax returns of any subsidiaries or affiliates for each of the three
preceding fiscal year-end periods.
OTHER REQUIREMENTS
Provide signature on the attached "Authorization, Certification and Notices."
"Representatives and Fees." If representatives were used, please complete the attached form.
Length of Time in Business. See below for additional requirements for applicants that have not been in business for
two full years as evidenced by tax returns reporting revenue.
Length of Time in Business Requirement
Eligibility criteria requires that an applicant concern must demonstrate that it has been in business in the primary industry
classification in which it seeks 8(a) BD certification for two full years prior to the date of its 8(a) BD application by submitting
income tax returns showing revenues for each of the two previous years. If the concern does not meet this requirement, the
concern must demonstrate potential for success. In determining potential for success, SBA will look at a number of factors
including, but not limited to: [13 C.F.R. 124.111(f)]
A.

Technical and managerial experience and competency of the individual(s) who manage and control the daily operations
of the concern;

B.

The financial capacity of the concern; and

C.

The concern's record of performance on any previous Federal or private sector contracts its primary industry
classification.

SBA Form 1010B - CDC (8-04)

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AUTHORIZATION, CERTIFICATION AND NOTICES
Read the following paragraphs carefully. Your signature on the 8(a) BD Business Eligibility Statement
indicates acceptance and understanding of these conditions.
A.

Authority to Collect Personal Information: The U.S. Small Business Administration (SBA) is authorized to determine
eligibility for the 8(a) BD Program under Section 124 of Title 13 of the U.S. Code of Federal Regulations. The
information submitted on the SBA Form 1010A and 1010B is used to determine personal and business eligibility for
the 8(a) BD Program. Information submitted may be given to Federal, State and local agencies for law enforcement
purposes.

B.

Incomplete Applications: If the application is not complete, SBA will return the application to you along with a
listing of missing or incomplete documentation. You may then reapply when the application is complete.

C.

Disclosure of Information: All information submitted in connection with this application may be disclosed to
Federal procurement agencies considering furnishing contracts to this business.

D.

Payment to SBA Employees: Payment of any fee or gratuity to SBA employees is illegal and will subject the
parties of such a transaction to prosecution.

E.

Access to Records: Applicant agrees to allow SBA access and the right to examine corporate records including, but
not limited to, books, documents, papers and other material considered by SBA to be necessary.

F.

True and Complete Statements: By signing this form, you are certifying that all information in your 8(a) BD
application, including exhibits, is true and complete to the best of your knowledge and is submitted for
consideration of 8(a) BD Program eligibility.

FOR CORPORATIONS ONLY:
Corporate Seal (if required by state):
By:

President's Signature

Attest By: Corporate Secretary's Signature

Date:
Date:

FOR PARTNERSHIPS ONLY:
All partners must sign:
Partner:
Partner:

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Partner:

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Partner:
Partner:

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Partner:

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Date:
Date:
Date:
Date:
Date:
Date:

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SBA Form 1010B - CDC (8-04)

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FOR LIMITED LIABILITY COMPANIES ONLY:
All members must sign:
Member:

Date:

Member:

Date:

Member:

Date:

Member:

Date:

Member:

Date:

Under Title 18 U.S.C. Section 1001 and Title 15 U.S.C. Section 645, any person who misrepresents a firm's status
as an 8(a) business concern, or makes any other false statement in order to influence the certification process in
any way, or to obtain a contract awarded under the preference programs established pursuant to section 8(a), 8(d),
9, or 15 of the Small Business Act, or any other provision of Federal Law that references Section 8(a) for a
definition of program eligibility shall be:
1.

Subject to fines and imprisonment of up to 5 years, or both, as stated in Title 18 U.S.C. Section 1001; and
subject to fines of up to $500,000 and imprisonment of up to 10 years, or both, as stated in Title 15 U.S.C.
Section 645.

2.

Subject to civil and administrative remedies, including suspension and debarment.

3.

Ineligible for participation in programs conducted under the authority of the Small Business Act.

SBA Form 1010B - CDC (8-04)

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REPRESENTATIVES AND FEES
It is not necessary for you to retain representation to assist in the preparation of this or any other 8(a) application.
However, if you do retain such representation, SBA will determine the reasonableness of fees or other compensation for
services actually performed by representatives on your behalf.
List the names of attorneys, accountants, appraisers, agents or other representatives who assisted in the preparation or filing
of the application. Indicate the amount of fees, bonuses, commissions or expenses paid or due. SBA reserves the right to
require, at a later date, a full itemization by representatives of actual services rendered. Attach additional sheet(s), if
necessary.
NAME AND OCCUPATION
OF REPRESENTATIVE

DESCRIPTION OF SERVICES

TOTAL FEES
PAID DUE

The compensation received by an agent or representative of an 8(a) BD application for assisting the applicant in
obtaining 8(a) BD certification must be reasonable in light of the services performed by the agent or representative.
The fee charged by any agent or representative of an 8(a) BD applicant for assisting the applicant in obtaining 8(a) BD
certification cannot by contingent upon the applicant receiving certification.
Signature(s) of Representative(s)

Date

Signature of Applicant

Date

SBA Form 1010B - CDC (8-04)

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