Dot F 2311-1 Stlp Checklist For New Applicants

OMB NO.: 2105-0555

EXPIRATION DATE: MM/DD/YYYY

SHORT TERM LENDING (STLP) CHECKLIST FOR NEW APPLICANTS

1. _____ Completed DOT OSDBU STLP application signed and dated.

2. _____ Financial Records for business:

_____Three years of business financial statements

Note: Business financial statements should be prepared by an independent CPA firm and to include the accountant's cover letter, balance sheet, operating statement, any additional statements and schedules, and any accompanying notes. If the latest financial statements are more than 90 days old, interim financial statements are to be furnished which may be management prepared.

_____Three years of business federal tax returns

3. _____ Financial Records personal: (for each proposed guarantor and individual owning 20% or more of the company)

_____Current personal financial statement (dated and signed)

_____Three years of personal income tax returns

4. _____ Current Work in Progress (WIP) Schedule or statement to include all jobs currently under contract. (Contract owner, project name, contract amount, start date, percentage completed and billed amounts, collected amounts, and estimated completion date should be included)

5. _____ Current Aging Reports of both Receivables and Payables (should be 90 days current)

6. _____ Cash Flow Projection covering the term of the loan must be submitted. This report should show, on a monthly basis, total revenues from both transportation and non-transportation related contracts in progress, the associated cost of goods and services, general and administrative operating costs, net monthly cash flow, and anticipated advances and repayment on the proposed line of credit.

7. _____ Current DBE Certification and/or other eligible SBA certification (8a, HUBZone, SDB, DSV). This is to include updated an annual affidavit as part of the certification requirements and evidenced of acceptance by the DOT by your home state or your Business Opportunity Specialist (BOS) if it is a SBA certification.

8. _____ Business formation documents (Articles of Incorporation, or Partnership Agreement, or Articles of Organization) and evidence of proper business registration.

9. _____ Company history and a statement of the expected benefits of the loan.

9. _____ List of completed contracts during the past 12 month period.

9. _____ 2 Reference letters relating to the applicant’s contract performance and one other reference letter relating to either financial or professional performance. These letters should be dated within the past six months of the date of application.

9. _____ Resume of key management

9. _____ Complete copy of all transportation-related contracts, subcontracts, and/or purchase orders that will be assigned to the proposed loan.

9. _____ Bonding information, if applicable

9. _____ If any of the principal owners of the applicant business also own a majority interest in other business concern, he/she must submit the past three fiscal years of financial statements and/or federal tax returns for the each affiliated business.

____________________________________________________________________________

PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT

A Federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. The OMB Control No. for this information collection is 2105-0555. The information requested on this form is being collected and disseminated by the U.S. Department of Transportation, Office of the Secretary as a courtesy to the public. Public reporting for this collection of information is estimated to be120 minutes per response, including time for reviewing instructions, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to: Information Collection Clearance Officer, Office of the Secretary, Office of Small and Disadvantaged Business Utilization, Financial Assistance Division, 1200 New Jersey Ave., S.E., 5^th Floor, W56-497, Washington, DC 20590.

PRIVACY ACT STATEMENT

The Privacy Act requires that we provide you with the following information regarding our use of your Personally Identifiable Information. The information on this application is solicited under the authority of Title 49 U.S.C. 332(b)(3)(4)(5) which authorizes DOT OSDBU to assist Disadvantage Business Enterprises and Small and Disadvantaged Business in acquiring access to working capital and to debt financing, in order to obtain transportation related contracts wholly or partially funded by DOT. Your request cannot be processed unless the data is complete. Disclosures of name and other personal identifiers are required for a benefit, as DOT requires an individual seeking assistance from DOT to provide with sufficient information for it to evaluate the risk of a loan application. In making loan guarantees pursuant to Title 49 U.S.C. 332(b)(3)(4)(5), DOT is required to have reasonable assurance that the loan is of sound value and will be repaid or that is in the best interest of the Government to grant the assistance required. Routine uses of records maintained in the system include: processing, review, and final approval of your loan by authorized Office of Small and Disadvantaged Business Utilization (OSDBU) personnel; internal loan review and independent financial analyst provided by a financial expert contractor working for OSDBU; the loan referral to a Participating Lender involved in the underwriting, loan approval, and loan servicing of the loan guarantee; and recording in the Grant Information System. Disclosure of your Social Security Number (SSN) and/or date of birth (DOB) are optional. Refusal to furnish your SSN and/or DOB will not result in the denial of any right, benefit or privilege provided by law; however, failure to provide SSN and/or DOB may result in the delay of a response of the processing of your loan application or its rejection. Routine uses of your social security number include: processing, review, and final approval of your loan by authorized Office of Small and Disadvantaged Business Utilization (OSDBU) personnel; internal loan review and independent financial analysis provided by a financial expert contractor working for OSDBU; and the loan referral to a Participating Lender involved in the underwriting, loan approval, and loan servicing of the loan guarantee.

DOT F 2311-1