Form SBA FORM 2417 SBA FORM 2417 APPLICATION FOR SELECTION

O MB Control No. 3245____

Expiration Date ____

Intermediary Lending Pilot (ILP) Program

U.S. Small Business Administration

Application for Selection

Part I, Management Assessment Questionnaire (MAQ)

Name of Intermediary Applicant
Address
Contact Person
Telephone
FAX
Email

Date of Receipt (Agency Use Only)

SBA is collecting the information on this application to determine whether the applicant meets the qualification and eligibility requirements to participate in the Intermediary Lending Pilot (ILP) Program as an ILP Intermediary Lender. SBA is collecting this information pursuant to the rules and regulations establishing the ILP Program in 13 CFR Part 109. The information collected on this form will be kept confidential to the extent permitted by law, including the Freedom of Information Act, 5U.S.C. 552 and the Privacy Act 5 U.S.C. 552a.

The estimated burden for completing this Application is 35 hours. You are not required to respond to this application unless it displays a current Office of Management and Budget (OMB) control number. If you have questions or comments concerning this estimate or other aspects of this information collection, please contact the U.S. Small Business Administration, Chief, Administrative Information Branch, Washington, DC 20416 and/or Office of Management and Budget, SBA Desk Officer, New Executive Office Building, Room 10202, Washington, DC 20503. Please do not send completed application forms to OMB.

Submit completed applications to:

U. S. SMALL BUSINESS ADMINISTRATION

Office of Financial Assistance – Microenterprise Development Branch

Attention: Jody Raskind, Chief

409 3rd Street, SW

Suite 8200

Washington, DC 20024-3212

Tel: (202)205-6485 Fax: (202)205-7722

INTRODUCTION

The entire Intermediary Application can be downloaded in a fillable PDF format from SBA’s web site at http://www.sba.gov/content/intermediary-lending-pilot. The Application is divided into two parts:

• Part I, Management Assessment Questionnaire (MAQ)

• Part II, Exhibits

Your organization must submit a complete Application. Applications will be considered incomplete if questions remain unanswered within the Application document. Attaching documentation in lieu of completing questions in this Application is not sufficient. Incomplete Applications will not be considered by SBA.

The length of your responses will have no effect on your organization’s selection as an ILP Intermediary. More important is the internal integrity, consistency, coherence, and clarity of the information provided. Therefore, please include responses to the application without unnecessary embellishment.

Prior to answering any question in this Application, your organization should read and become familiar with:

• All of the regulations found in 13 CFR Part 109. This information includes definitions used in this Application and can be downloaded from SBA’s web site at http://www.sba.gov/content/intermediary-lending-pilot. And,

• The Notice of Funds Availability (NOFA) and the Program Announcement referenced within the NOFA, which can be obtained from SBA’s web site at http://www.sba.gov/content/intermediary-lending-pilot.

The following terms used within this Application (not defined in the regulations) have specific meanings in the context of this Application:

• Application – refers to SBA Form 2417, which includes Part I, Management Assessment Questionnaire (MAQ) and Part II, Exhibits.

• Exhibits – refers to Part II of SBA Form 2417.

• Intermediary Applicant – refers to the entity applying to become an ILP Intermediary.

• Officer – refers to board members or anyone authorized and empowered to legally or financially bind the Intermediary and/or to execute any agreements in the name and on behalf of the Intermediary.

• Your organization – refers to the Intermediary Applicant, not any individual Officer or Associate, unless specifically stated otherwise.

INSTRUCTIONS

1. Answer all questions in the limited space provided and attach all Exhibits in Part II of this Application. Failure to provide all requested information in an orderly and organized fashion may result in SBA rejecting your Application.

2. If applying as a consortium, each entity of the consortium must individually complete a full Application, which the consortium applicant must compile and submit as one application package.

3. Submit one (1) complete, original hard copy set of the Application (Part I and Part II, including all exhibits). Place the original set in a large, 3-ring binder and label with the Intermediary Applicant’s name.

4. Also, submit Part I (MAQ) in PDF format and Part II (the Exhibits) in Word or PDF format on a standard Compact Disc with your hardcopy submission. The electronic version of these documents must be identical to the hardcopy you also submit.

5. If a question is “not applicable” write “N/A.”

6. Attach all required Exhibits in Part II of the Application. If you wish to provide supplemental documents in response to a particular question in Part I (e.g. annual reports, marketing materials, related press, standard loan documentation, etc.), you may attach such information in Exhibit M.

7. Ensure that all required signatures appear on all Exhibits requiring a signature.

8. Due to the required irradiation of regular mail prior to its delivery to Federal offices in the Washington, D.C. area, organizations are encouraged to use a “next day” or “overnight delivery” method to ensure the timely receipt of materials at the address below by time and date certain. Submit completed applications to:

U. S. SMALL BUSINESS ADMINISTRATION

Office of Financial Assistance – Microenterprise Development Branch

Attention: Jody Raskind, Chief

409 3^rd Street, SW Suite 8200 Washington, DC 20416

Tel: (202)205-6485 Fax: (202)205-7722

Carefully re-read these instructions and refer to them as you review your entire Intermediary Application to ensure that you have

followed each instruction before submitting the Intermediary Application.

Do not rely upon any advisor to do this for you.

RESOLUTION OF BOARD OF DIRECTORS

Instructions and Applicability

SBA Form XX, ILP Program Resolution of the Board of Directors, is to be properly executed by the Intermediary Applicant prior to submission of the Application. If submitting on behalf of a consortium of private, nonprofit organizations or nonprofit community development corporations, each member of the consortium must execute this resolution. Submit a copy of this Resolution as Exhibit B to Part II of this Application.

The Resolution of the Board of Directors authorizes the representative(s) identified in the Resolution to submit an application on behalf of the organization for selection as an ILP Intermediary and for an ILP Loan.

Certifications

1. As an authorized representative of the Intermediary Applicant, I certify that all information submitted in connection with SBA Form 2417 is true and accurate to the best of my knowledge. I understand that knowingly making a false statement in connection with this Application is a violation of Federal law and is subject to criminal prosecution and civil penalties under 18 USC §§ 287, 371, 1001, and 1006; 15 USC § 645; and 31 USC § 3729.

2. If selected as an ILP Intermediary, the organization will operate in full conformity with Section 7(l) of the Small Business Act, as amended (15 USC 636(l)), material statements in the application, and SBA regulations at 13 CFR Part 109. I understand that if an ILP Loan is obtained on the basis of this Application, this Application will become an agreement with the SBA within the meaning of 13 CFR Part 109 Subpart C – ILP Program Requirements.

3. As an authorized representative of the Intermediary Applicant, I certify that the organization is not delinquent on any debt to the Federal Government.

4. As an authorized representative of the Intermediary Applicant, I provide SBA permission to obtain additional information regarding the Intermediary Applicant’s relationship with creditors, other federal agencies, or other entities as necessary to evaluate this Application.

Intermediary Applicant Name
Authorized Representative Name
Authorized Representative Signature
Title
Date

Section 1. ELIGIBILITY

1. Is the Intermediary Applicant recognized by the IRS as tax-exempt (see 13 CFR §109.100(a))?

Yes

No

If “yes,” submit IRS documentation of the tax-exemption in Exhibit C.

If “no,” your organization is not eligible for selection as an ILP Intermediary and your application will not be scored.

2. Is the Intermediary Applicant an SBA Microloan Intermediary?

Yes

No

If “yes,” your organization is not eligible for selection as an ILP Intermediary and your application will not be scored (see 13 CFR § 109.100(a)).

1.3 Select under which organization type you qualify as an eligible entity (see 13 CFR §109.100(a)):

• Private, nonprofit community development corporation;

• Consortiums of private, nonprofit organizations or nonprofit community development corporations;

• Agencies of or nonprofit entities established by Native American tribal governments; or

• Other private, nonprofit entity.

If your organization selects “other,” please describe your organization.

1.4 Does your organization have at least one year of experience making loans of $200,000 or less to startup, newly established, or growing small business concerns?

Yes

No

If “no,” your organization is not eligible for selection as an ILP Intermediary and your application will not be scored.

1.5 Does your organization have any outstanding SBA Disaster loans?

Yes

No

If “yes,” what is your organization’s total outstanding debt to SBA?

$

If greater than $1 million, your organization is not eligible for selection as an ILP Intermediary and your application will not be scored.

Section 2. ORGANIZATION

2.1 Full Legal Name

(a) What is the full legal name of the Intermediary Applicant?

(b) If applicable, what is the dba name or name by which your organization is recognized?

2.2 Employer Identification Number (EIN):

2.3 Address(es):

Address of Main Office		Address(es) of Branch Office(s)
Website 

2.4 (a) Amount of ILP Loan requested from SBA (up to $1 million).

$

(b) If less than $1 million, explain why. (not to exceed 2000 characters)

2.5 Structure and relationships.

1. In Exhibit C, provide copies of the Intermediary Applicant’s articles of incorporation and bylaws, as amended.

(b) In Exhibit D, provide a copy of your organizational chart(s). Identify all Officers, Associates, and boards or committees on the chart(s). If the Intermediary Applicant has Affiliates, provide an organizational chart identifying the relationship between the Intermediary Applicant and all Affiliates (as defined in 13 CFR 109.20).

In narrative accompanying the charts, identify members of any boards or committees of the Intermediary Applicant and provide descriptions of the roles and responsibilities of these boards or committees. In Exhibit E, submit a resume and SBA Form 1081 for each member of the Board of Directors.

3. Provide the name, date of formation, and jurisdiction of legal formation for any Affiliates specified in your organizational chart(s). (not to exceed 2000 characters)

3. Describe all existing or anticipated contractual relationships with Affiliates (e.g. overhead absorption, personnel provided, technical assistance services provided, etc.) specific to the delivery of the ILP program and provide copies of any such agreements in Exhibit L. (not to exceed 4000 characters)

2.6 (a) List each of your organization’s Officers, Associates and any personnel involved in day-to-day management. List corresponding titles and functions, summarizing roles (add/delete rows as necessary). Please also specifically identify paid staff integral to the implementation, servicing, and reporting for the ILP program.

Organization Officers & Personnel
Name	Title	Years in Organization	Role in Organization

(b) For each individual listed in Question 2.6 (a), submit a resume and SBA Form 1081 in Exhibit E.

2.7 (a) Does your organization or any of its Affiliates participate in any other SBA programs?

Yes

No

If yes, what programs? Please list. (not to exceed 2000 characters)

2. Has your organization or any of its Affiliates applied to participate in any other SBA programs?

Yes

No

If yes, please identify the program(s) and indicate the amount of funding your organization has obtained or anticipate seeking under such programs. (not to exceed 2000 characters)

2.8 (a) Does your organization participate in any non-SBA Federal programs?

Yes

No

If yes, what programs? Please list. (not to exceed 2000 characters)

2. Is your organization in compliance with the requirements of each of the programs listed above? If not, please explain. (not to exceed 4000 characters)

Section 3. lending Plan NARRATIVES

3.1 Discuss your organization’s proposed lending strategy for the ILP program and what it brings to small business lending that makes your organization uniquely qualified to participate in the ILP program. Include in your discussion the type of small businesses that your organization anticipates assisting. (not to exceed 4000 characters)

3.2 (a) Describe briefly the geographic area in which your lending activities currently take place and any specific criteria you may use to define those areas (e.g. eligible city, county, State divisions, census tracts, etc.). (not to exceed 2000 characters)

2. Identify specific economic, poverty and unemployment characteristics of your organization’s current geographic area and how these characteristics impact your lending strategy. (not to exceed 2000 characters)

3. If known, discuss the approximate percentage of your organization’s small business loans of $200,000 or less that are directed to one or more underserved areas (e.g. HUBZones, Low- or Moderate Income LMI Areas, or Empowerment Zones/Renewal Communities). (not to exceed 2000 characters)

4. Does your organization intend to target the same geographic area, as described in Question 3.2 (b) for the ILP program? If different from your current geographic area, please explain. (not to exceed 2000 characters)

4. In Exhibit F, provide a map of your proposed targeted geographic area for the ILP program.

3. (a) Discuss the extent of demand for small business loans of $200,000 or less in your organization’s ILP targeted geographic area and provide the basis for such estimates (e.g. customer inquiries, results of surveys, etc.). (not to exceed 3000 characters)

(b) Provide an assessment of why small businesses in your organization’s ILP targeted geographic area are unable to obtain the services they need from other financial institutions. (not to exceed 2000 characters)

3. Only small businesses for which credit is not otherwise available on reasonable terms from non-Federal sources (e.g. traditional bank loans) are eligible to receive a loan under the ILP program. How will your organization ensure that proceeds from ILP loans are directed toward such applicants? (not to exceed 2000 characters)

3.4 (a) In the chart below, illustrate how many small business loans of $200,000 or less your organization has made in the last five (5) years in both number and total dollars and percentage of total portfolio.

	$0 to $50,000			$50,001 to $200,000
Year	#	$	% of Total Portfolio	#	$	% of Total Portfolio
		$			$
		$			$
		$			$
		$			$
		$			$
Totals		$			$

2. An ILP Intermediary must commit 100% of its ILP Loan funds within two (2) years of the date of the ILP Note (see 13 CFR 109.340(a)). Provide the number and size of loans your organization anticipates making through the ILP program during the first two (2) years of participation in the ILP program.

	$1 to $50,000		$50,001 to $100,000		$100,001 to $150,000		$150,001 to $200,000		Total Loans ≤$200,000
Year	#	$	#	$	#	$	#	$	$
		$		$		$		$	$
		$		$		$		$	$
		$		$		$		$	$
Totals		$		$		$		$	$

3.5 The ILP program requires that ILP Intermediaries relend the funds in the ILP Relending Fund so that the total principal balance of loans outstanding to Eligible Small Business Concerns does not fall below 75% of the outstanding principal balance of the ILP Loan at any time (see 13 CFR 109.340(b)). What is your organization’s experience with relending loan funds and how do you intend to meet this relending requirement? (not to exceed 3000 characters)

3.6 (a) The ILP program requires ILP Intermediaries to provide loans of $200,000 or less to Eligible Small Business Concerns. What rates and/or terms does your organization anticipate providing under this program? Include details such as interest rates, loan payment structures, amortization periods, flexible credit standards, lines of credit, collateral requirements, and debt service coverage requirements. (not to exceed 5000 characters)

The maximum interest rate the ILP Intermediary may charge for loans less than or equal to $50,000 is 8.75 percent. The maximum interest rate the ILP Intermediary may charge for loans greater than $50,000 is 7% (see 13 CFR 109.420(d)).

SBA regulations limit application and/or origination fees that ILP Intermediaries may charge Eligible Small Business Concerns to less than or equal to one (1) percent of the small business loan amount (see 13 CFR 109.420(e)).

2. Explain how these proposed rates and terms compare with what is offered by other lenders in your organization’s targeted geographic area. (not to exceed 3000 characters)

2. Discuss how the proposed ILP products, rates, and/or terms differ, if at all, from your organization’s current products and services offered. (not to exceed 3000 characters)

3.7 (a) Does your organization anticipate offering lines of credit as part of your ILP lending strategy?

Yes

No

If “yes,” illustrate your organization’s experience with originating lines of credit over each of the last five (5) years in the chart below.

Year	Number of Revolving Lines of Credit Committed	Total Committed Revolving Dollars	Percent of Revolving Lines of Credit in the Total Loan Portfolio
		$	%
		$	%
		$	%
		$	%
		$	%
Totals		$	%

2. If “yes,” discuss your organization’s experience with delinquency and charge-off rates for revolving lines of credit over each of the last five (5) years. (not to exceed 3000 characters)

3.8 (a) Does your organization anticipate lending to startups as part of your ILP lending strategy? SBA considers startups as businesses in operation for less than two years.

Yes

No

If “yes,” illustrate your organization’s experience with originating loans to startups over each of the last five (5) years in the chart below.

Year	Number of Committed Startup Loans	Total Startup Dollars	Percent of Startup loans in the Total Loan Portfolio
		$	%
		$	%
		$	%
		$	%
		$	%
Totals		$	%

2. If “yes,” discuss your organization’s experience with delinquency and charge-off rates for loans to startup small businesses over each of the last five (5) years. (not to exceed 3000 characters)

3.9 How does your organization intend to mitigate risks associated with the lending strategy described in this application (e.g. providing technical assistance)? If applicable, describe your organization’s prior experience with such mitigation measures. (not to exceed 4000 characters)

3.10 Underwriting

1. Provide a copy of your organization’s underwriting policies and procedures in Exhibit G. In the chart below, indicate whether your organization’s policies and procedures address the following processes and if so, reference the appropriate section within the policies and procedures document:

Processes for:	Yes	No	Reference
Evaluating creditworthiness
Conducting due diligence and making initial loan decisions
Setting interest rates
Determining risk level
Collateral requirements
Making final loan decisions

2. Discuss how your organization’s existing underwriting policies may change, if at all, for loans made under the ILP program if selected by SBA as an ILP Intermediary. (not to exceed 3000 characters)

3.11 Loan Loss Reserves

(a) What percentage of your small business loan portfolio (of loans of $200,000 or less) does your organization set aside as a loan loss reserve? What method does your organization use to establish and maintain an appropriate loan loss reserve? (not to exceed 3000 characters)

(b) ILP regulations require that intermediaries maintain a cash loan loss reserve of not less than 5% of the principal balance of all outstanding loans made to Eligible Small Business Concerns with ILP loan proceeds (see 13 CFR 109.350).

Discuss how your organization’s existing loan loss reserve policies may change, if at all, for loans made under the ILP program if selected by SBA to become an ILP Intermediary. (not to exceed 3000 characters)

3. Describe the resources available to your organization to establish and maintain the loss reserve. ILP Relending Fund may not be used to fund the loss reserve. However, interest income and proceeds from fees may be used to assist with this requirement. (not to exceed 3000 characters)

3. Describe the processes and procedures your organization uses to keep loan loss reserve funds secure and separate from other operating funds. (not to exceed 2000 characters)

3.12 Portfolio Review and Monitoring

1. Provide a copy of your organization’s policies and procedures related to portfolio management in Exhibit H. In the chart below, indicate whether your organization’s policies and procedures address the following processes and if so, reference the appropriate section within the policies and procedures document.

Processes for:	Yes	No	Reference
Frequency of portfolio reviews
When to charge-off loans
Conducting intensive servicing
Liquidation and debt collection

2. Discuss how your organization’s existing policies may change, if at all, for loans made under the ILP program if selected by SBA as an ILP Intermediary. (not to exceed 3000 characters)

(c) Using the chart below, provide your organization’s delinquency rate and cumulative default rate for outstanding small business loans of $200,000 or less for each of the last five (5) years.

Small Business Loans of $200,000 or less
Fiscal Year End	Principal balance > 60 days past due (Column A)	Total principal balance outstanding at Fiscal Year End (Column B)	Delinquency Rate (Col A/Col B)	Cumulative Net Write-offs or Charge-offs for most recent 5 years (Column C)	Cumulative Loans Originated for most recent 5 years (Column D)	Cumulative Default Rate (Col C/Col D)
	$	$	%	$	$	%
	$	$	%	$	$	%
	$	$	%	$	$	%
	$	$	%	$	$	%
	$	$	%	$	$	%

(d) If not already addressed in your organization’s policies and procedures, describe the methods your organization uses to monitor and address delinquencies and defaults in your organization’s portfolio. (not to exceed 3000 characters)

3.13 Performance Metrics

1. Describe any outcomes achieved by your organization’s small business lending strategy such as, but not limited to: job creation, quality of jobs created (e.g. access to living wages, health care, etc.), number of small businesses assisted, and graduating borrowers into traditional financing over each of the last three (3) years. (not to exceed 3000 characters)

(c) If available, provide the number of full time equivalent (FTE) jobs created/retained by your organization’s small business borrowers over the last three (3) years. FTE is generally defined as total weekly hours worked divided by 35 hours.

Year	Total Number of FTEs Created and Retained for all Loans	Total Number of FTEs Created and Retained for Small Business Loans Under $200,000

Section 4. FINANCIAL HEALTH AND Capitalization

4.1 (a) Submit your most recent audited or reviewed financial statements in Exhibit I. Identify the type of financial statement submitted:

Audited
CPA-Reviewed
Compiled

If you selected anything less than an audited financial statement, explain whether your organization will have the capacity to submit an audited financial statement, as required by 13 CFR § 109.360(b)(3), if selected to participate as an ILP Intermediary. (not to exceed 2000 characters)

(b) In the previous year, did your organization receive any of the following by a third-party auditor:

1. An opinion other than “unqualified”?

Yes

No

2. A going concern paragraph?

Yes

No

3. Findings of reportable conditions?

Yes

No

4. Material weaknesses in internal control?

Yes

No

5. OMB Circular A-133 audit findings?

Yes

No

N/A

(c) If you selected “yes” to any of the subparts in Question 4.1 (b), please discuss the corrective measures/actions taken by your organization and submit any responses to findings/measures included in the financial statements in Exhibit I. (not to exceed 4000 characters)

4.2 (a) Is your organization regulated by a Federal entity, other than SBA?

Yes

No

If “yes,” identify the regulator.

(b) Is your organization regulated by a State entity?

Yes

No

If “yes,” identify the regulator.

3. If “yes,” to Questions 4.2 (a) or (b), is your organization in good standing with your regulator?

Yes

No

N/A

If “no,” please explain. (not to exceed 3000 characters)

4.3 Sources and Availability of Capital

(a) List any sources of funding that have provided 10% or more of your operating capital during any of the three (3) most recent fiscal years. Also provide the type of the source (e.g. foundations, financial institutions, high net-worth individuals, etc.); the years provided; whether the funds are for general purposes or program-specific; whether the funds are restricted or unrestricted; and the amounts received in the years noted.

Name & Type of Capital Source	Years	General or Program Specific	Restricted or Unrestricted	Total $
				$
				$
				$
				$
				$

2. Discuss your organization’s cost of capital. (not to exceed 2000 characters)

4.4 How does your organization intend to cover the costs of this program? (not to exceed 2000 characters)

4.5 (a) Discuss your organization’s ability to achieve positive increases in net assets. (not to exceed 2000 characters)

2. Provide your organization’s net asset or capital ratio (calculated as net assets divided by total assets) for your organization’s most recent fiscal year. Discuss your organization’s ability to maintain a sufficient cushion of net assets to cover unexpected losses. If your capital ratio is less than 0.20, discuss any plan your organization has to increase this ratio. (not to exceed 3000 characters)

4.6 (a) Discuss your organization’s ability to maintain sufficient cash to cover short-term operating expenses. (not to exceed 2000 characters)

(b) Provide your organization’s operating liquidity ratio (calculated as unrestricted cash and cash equivalents divided by current liabilities) for your organization’s most recent fiscal year. If your operating liquidity is less than 1.0, discuss any plan your organization has to increase this ratio. (not to exceed 3000 characters)

[End of Questionnaire]

Part II, EXHIBITS

1. List of Exhibits to ILP Intermediary Application

When compiling each Exhibit listed below, use this Exhibit A as both a checklist and table of contents for your hardcopy submission.

Tab each Exhibit in your hardcopy submission with the corresponding Exhibit letter.

Label each Exhibit in your electronic submission with the corresponding Exhibit letter and the Intermediary Applicant’s name (acronyms or shortened versions will be acceptable).

2. SBA Form XX, Resolution of Board of Directors

Submit this Exhibit B, SBA Form XX, ILP Program Resolution of Board of Directors, following the instructions provided, with the application submission. An electronic copy of SBA Form XX can be obtained at http://www.sba.gov.

3. Organizational Documents – Tax-exempt documentation, Bylaws, and Articles of Incorporation

Submit this Exhibit C with the application submission, as required by Questions 1.1 and 2.5(a) of Part I, MAQ, and include the following:

• A copy of the applicant’s IRS tax exempt certificate; and

• A complete copy of the applicant’s Articles of Incorporation and Bylaws, as amended.

4. Organizational Chart(s)

You must submit this Exhibit D with the application submission, as required by Question 2.5(b) of Part I, MAQ. Include a narrative supporting statement explaining the organization chart.

Please include in your organization chart all Officers, Associates, Affiliates, and Boards or Committees of the ILP Intermediary Applicant, identifying each individual by name and title.

5. Business Experience & Education

Submit this Exhibit E with the application submission. Each individual listed in response to Questions 2.5(b) and 2.6 of Part I must submit a Statement of Personal History (SBA Form 1081) and Resume as described below. The terms “you” and “I” as used in this Exhibit refers to the individuals completing the Exhibit.

Statements of Personal History

For each individual, provide a completed SBA Form 1081, Statement of Personal History, following the instructions provided. An electronic copy of SBA Form 1081 can be obtained at http://www.sba.gov/content/sba-form-1081-statement-personal-history-non-bank-lenders-cdcs-and-micro-lenders.

Resumes

For each individual, provide a resume (not a narrative) of relevant experience and education, with dates and addresses shown. Do not exceed three pages in type no smaller than 11 pt. Arial or Times Roman.

• Relate your business and professional experience as well as any prior experience that relates to your qualifications to participate in the ILP program. Give the title of each position, and describe the basic functions and responsibilities.

• Regarding education, list your degrees, major areas of study, and names of the institutions attended.

• If desired, you may also include any other information in your resume that you consider relevant to demonstrate qualifications.

7. Map of Targeted Geographic Area

You must submit this Exhibit F with the application submission. You must display a map(s) to visually represent the targeted geographical area(s) in which you intend to target your lending activities, as required by Question 3.2(e) of Part I, MAQ. You may submit multiple maps if necessary to adequately demonstrate your targeted area.

8. Underwriting Policies & Procedures

Submit this Exhibit G with the application submission as required by Question 3.10(a) of Part I, MAQ. Insert the ILP Intermediary Applicant’s Underwriting Policies & Procedures.

9. Portfolio Management Policies & Procedures

Submit this Exhibit H with the application submission as required by Question 3.12(a) of Part I, MAQ. Insert the ILP Intermediary Applicant’s Portfolio Management Policies & Procedures.

10. Financial Statements

Submit this Exhibit I with the application submission. Submit the ILP Intermediary Applicant’s most recent audited or reviewed financial statements (as prepared by a certified public accountant is acceptable if audited financial statements are not available).

Also, submit any responses to findings/measures included in the financial statements and any corrective measures/actions taken in response.

11. SBA Form 1624, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion

Submit this Exhibit J, SBA Form 1624, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion, following the instructions provided, with the application submission. An electronic copy of SBA Form 1624 can be obtained at http://www.sba.gov/content/certification-regarding-debarment-suspension-ineligibility-and-voluntary-exclusion-lower-tier-covered-transactions.

12. SBA Form 1711, Certification Regarding Lobbying

Submit this Exhibit K, SBA Form 1711, Certification Regarding Lobbying, following the instructions provided, with the application submission. An electronic copy of SBA Form 1711 can be obtained at http://www.sba.gov/content/sba-form-1711-certification-regarding-lobbying-0.

13. Contractual Agreements

If you have contractual relationships to support operating costs, technical assistance or other activities, to the extent practicable, submit copies of those contracts in this Exhibit L, as indicated in Question 2.5(d) of Part I, MAQ.

14. Supplemental Information

If you wish to provide supplemental documents in response to a particular question in Part I (e.g. annual reports, marketing materials, related press, standard loan documentation, etc.), you may attach such information in Exhibit M. Identify the documents you have included in Exhibit M in your response to the applicable question in Part I.

NOTICES REQUIRED BY LAW

PRIVACY ACT (5 U.S.C. 522a)

Portions of this application collect personal information on each Officer of the ILP Intermediary applicant. SBA will use the information in connection with an investigation of each ILP Officer’s experience and character. The scope of this investigation may include contact with individuals, business associates, banks, other financial institutions, law enforcement offices, and any others that will assist SBA in making an adequate appraisal of the Officer’s general business reputation and character.

The Debt Collection Improvement Act of 1996 (31 USC 7701(c) (1) permits a Federal agency to require each person doing business with that agency to furnish that person’s taxpayer identification number (TIN). A TIN is an identification number used by the Internal Revenue Service in the administration of tax laws, and includes employee identification numbers (EINs) and social security numbers (SSNs). Therefore, it is mandatory that you furnish your TIN. SBA may consider the general business reputation of ILP Intermediary Applicants in its determination of whether each Intermediary has the appropriate business experience necessary to participate in the ILP program. Providing TINs and other personal identifiers for each Officer of the ILP Intermediary will assist SBA in making these determinations required by law. If you do not provide the personal information requested, SBA may be unable to reach a favorable determination concerning your participation in the ILP program.

Any person can request to see or get copies of an individual’s personal information that SBA maintains in a record that is retrieved by personal identifiers, such as name or social security number (see 13 C.F.R. Part 102, Subpart B). However, requests for information about another party may be denied unless SBA has the written permission of the individual to release the information to the requestor or the information is subject to disclosure under the Freedom of Information Act (5 USC 552).

The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act.  One such routine use is the disclosure of information maintained in SBA’s investigative files system of records when this information indicates a violation or potential violation of law, whether civil, criminal, or administrative in nature.  Therefore, SBA may refer any such information to the appropriate agency, whether Federal, State, local or foreign, charged with responsibility for or otherwise involved in investigation, prosecution, enforcement or prevention of such violations.  Another routine use is disclosure to other Federal agencies conducting background checks, only to the extent the information is relevant to the requesting agencies’ function.  See, 74 F.R. 14890 (2009), and as amended from time to time, for additional background and other routine uses. 

Any person concerned with the collection of information, its mandatory or voluntary nature, disclosure or routine use under the Privacy Act may contact the SBA Privacy Act Officer, Freedom of Information/Privacy Acts Division, Small Business Administration, 409 Third Street, SW, Washington, DC 20416.

FREEDOM OF INFORMATION ACT (5 U.S.C. 552)

The Freedom of Information Act (FOIA) provides, with some exceptions, that SBA must make records or portions of records contained in its files available to persons requesting them. Such disclosure would generally include aggregate statistical information on the ILP program and other information such as names of awardees of ILP Loans and names of Eligible Small Business Concerns that have been financed by ILP Intermediaries. SBA does not make available to a third party your proprietary data or information that would cause competitive harm or would constitute a clearly unwarranted invasion of personal privacy.

To request information under FOIA, you must send the request to the SBA office maintaining the records requested and identify it as a FOIA request. The request must describe the specific records you want. For information about the FOIA, contact the U.S. Small Business Administration, Chief Agency FOIA Officer, FOI/PA Office, 409 3^rd Street, SW, Washington, DC 20416, or by e-mail at [email protected] .

SBA Form 2417 (X-XX)