2301- Part E Community Advantage Lender Participation Application

OMB Control No: 3245-0361

Expiration Date:

COMMUNITY ADVANTAGE LENDER PARTICIPATION APPLICATION

The Community Advantage Lender Participation Application (Application) should be completed by lenders requesting to approve loans under the Community Advantage Pilot Program (CA Pilot Program). Please complete Section 1 before completing Sections 2, 3 and 4. Section 1 will assist the lender in determining whether the organization meets the general eligibility requirements to participate in the CA Pilot Program. After completing the questions in Section 1 and the lender initially determines that it is eligible to participate in the CA Pilot Program, the lender should complete Sections 2, 3 and 4. If the lender determines that it is not eligible to participate in the CA Pilot Program, then the lender does not complete Sections 2, 3and 4.

Sections 3 and 4 identify all required documents that lenders must submit along with this Application. Also, please review the “Community Advantage Participant Guide” [add hyperlink] for a more detailed explanation of CA Pilot Program requirements.

SECTION 1. Lender’s Eligibility Questions

1. Identify lender’s type of organization:

SBA-CDC SBA-Micro-lender Community Development None of the Three Financial Institution (CDFI)

2. Does the Organization have an executed Loan Guaranty Agreement, Yes No

SBA Form 750, making it eligible to participate in SBA’s 7(a) loan program?

3. Has the Organization been in business for less than 12 consecutive months? Yes No

4. Is the Organization regulated by a Federal financial regulator? Yes No

If the Organization is an SBA-CDC, SBA-Micro-lender, or CDFI and answered No

to the preceding questions, it is eligible to participate in the CA Pilot Program.

If your Organization is not eligible to participate in the CA Pilot Program, please visit www.sba.gov for the location of the closest SBA District Office to determine which SBA program best fits your Organization’s needs. Please do not submit a Community Advantage Lender Participation Application.

SECTION 2. Lender Contact Information

Applicant Name

Business Address

Contact Person and Title

Telephone Number Fax Number

Business Email Addresses

What is the Organization’s Employer Identification Number?

What date was the Organization established?

Is Organization regulated by a State Agency? Yes No

Name of State Regulator (if applicable): _______________________________________________

Are you interested in selling your Community Advantage loans into the Secondary Market? Yes No

SECTION 3. Required Documents (Submit the documents identified in this section as part of Application)

ORGANIZATIONAL INFORMATION IRS Tax Exempt Certification Certificate of Good Standing from the Secretary of State Opinion of independent counsel that the lender is in compliance with applicable Federal, State and local laws in the formation and organization of the Lender List of officers and directors with resume and “Statement of Personal History,” SBA Form 1081, for each individual identified. For any officer that answered “yes” to question numbers 10a, 10b, 10c or 11on SBA From 1081 must also submit finger print cards.* List of key personnel who will be instrumental in administering the CA Pilot Program with a resume and “Statement of Personal History,” SBA Form 1081, dated within 90 days of submission to SBA, and fingerprint cards for each individual listed Certified copy of a Resolution of the Board of Directors authorizing submission of application, utilizing, Resolution of Board of Directors, SBA Form 160 If a CDFI, a copy of most recent certification from the US Treasury, CDFI Fund Not required if already submitted to SBA as part of SBA’s 504 or Micro loan programs

FINANCIAL AND OPERATIONAL INFORMATION A business plan including an organization chart and describing current small business lending activities and the nature of proposed operations for CA Pilot Program including small business lending, Management &Technical Assistance, and demographic and economic information in area of operations Year-end audited financial statements for the last two years.** Interim financial statements for period not covered by audited financial statements Schedule of sources of funding and funds available Schedule and reconciliation of loan loss reserve and description of allowance for loan loss reserve methodologies Copy of lending policies and procedures governing business loan origination, servicing and liquidation Any other information the lender considers relevant for SBA to consider in evaluating the application ** Not required if already submitted to SBA as part of SBA’s 504 or Micro loan programs

SECTION 3: Required Documents (Submit the documents identified in this section as part of Application)

SECTION 4: Representations and Certifications

Authorized Representative: The undersigned is an authorized representative of the Organization submitting an application to participate in the CA Pilot Program.

Organization: The undersigned certifies that they have filed articles of incorporation and by-laws with either the SBA or the CDFI Fund in connection with their participation in the 504, Microloan, and/or CDFI programs and that those organizing documents submitted have not materially changed. Alternatively, if material changes have occurred, the undersigned certifies that a copy of the current articles of incorporation and/or by-laws is included with this application.

State Regulation: The undersigned certifies that the Organization is not subject to regulation by a state financial regulator. Alternatively, if the Organization is subject to state regulation, the undersigned certifies that the Organization is in good standing with the State regulator and provides the following information to SBA with this application:

• Copy of the State statute or regulations governing the Organization’s operations

• Copy of the latest report of examination of Organization

• Description of State prescribed capital requirements and a certification that the Organization meets the established capital requirements.

Composition of Board/Officers: The undersigned certifies that it is an SBA-CDC and/or an SBA Micro-Lender, and that the identification of the organization’s officers and directors previously provided to SBA is current. Alternatively, if changes have occurred, the undersigned certifies that a list of the current officers and directors, with resumes, SBA Form 1081s and, as applicable, fingerprint cards for each new officer and director, is included with this application. This certification is not applicable to CDFIs.

Additional Information: The undersigned gives SBA permission to obtain any additional information necessary regarding applicant’s relationship with creditors, other federal agencies, or other entities as necessary to evaluate the application.

Correct Information: The undersigned also certifies that the information provided has been accurately prepared on behalf of the Organization and that the information is true and correct, to the best of my knowledge, and that due diligence has been exercised to obtain true and correct information. I realize that the penalty for knowingly making a false statement is that I may be fined up to $250,000 and/or be put in jail for up to five years under 18 USC 1001, and subject to other penalties as provided by law.

_______________________________

NAME:

TITLE:

DATE:

Where to send the application:

The Community Advantage Lender Participant Application should be sent to the following address:

U.S. Small Business Administration

Office of Risk Management

Attn: Community Advantage Pilot Program/Lender Application

409 3^rd Street, S.W., 8^th Floor

Washington, DC 20416

NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, and completing and reviewing the Section is 7 hours per response. Comments or questions on the burden estimates should be sent to U.S. Small Business Administration, Chief, AIB, 409 3rd St., SW, Washington DC 20416 and/or SBA Desk Officer, Office of Management and Budget, New Executive Bldg., Room 10202 Washington,  DC 20503. PLEASE DO NOT SEND FORMS TO THIS ADDRESS.

SBA Form 2301, Part E (Ver. 12-2010) 3