Ownership Distribution: (List stockholders, partners, owner names) Note: Attach separate sheet if additional space needed.

Transcription

1 Baltimore Business Recovery Loan Application BUSINESS INFORMATION Business Name Address Telephone ( ) Tax I.D. Individual Name(s) Address Telephone ( ) Social Security # Date of Birth: Proprietorship Partnership Sub-Chapter S _ Corporation _ Non-Profit _ Individual LLC Ownership Distribution: (List stockholders, partners, owner names) Note: Attach separate sheet if additional space needed. Name Title # of Years % SS# Name Title # of Years % SS# Name Title # of Years % SS# Year Business Established Number of Employees prior to loss Years at Present Location [ ] Own [ ] Lease Accountant Telephone ( ) Insurance Agent Telephone ( ) Attorney Telephone ( ) DESCRIPTION OF LOSS: LOAN REQUEST Amount of Loan Requested $ Specific Loan Purpose (Check all that apply) [ ] Purchase of Furniture, Fixtures or Equipment [ ] Finance Purchase of Inventory [ ] Other, Please describe 1

2 BUSINESS BACKGROUND INFORMATION Please describe a brief description of what type of business you have: MISCELLANEOUS INFORMATION Are tax liabilities current? [ ] Yes [ ] No Settled through CERTIFICATION The undersigned certifies that, to the best of his or her knowledge and belief, all information contained in this loan application and in the accompanying statements and documents is true, complete, and correct. The undersigned agrees to notify the BDC immediately of any material changes in this information. The undersigned authorizes BDC to contact any bank and trade creditors it deems necessary without further notice, including, but not limited to, Dunn & Bradstreet reports or information from TRW Credit Data. Business Name (print): Appliquant Signature: Applicant Title: Date: 36 S. Charles St., Suite 1600, Baltimore, MD, Phone: , Fax:

3 AFFIDAVIT OF PROPERTY LOSS I,, hereby attest, under penalty of perjury and upon personal knowledge, that the following information contained in this Affidavit of Property Loss is true and correct. Section I General Business and Loss Information A. I am the owner(s) of the business known as:, located at (the Business ). B. The Business is a (select one): Corporation Limited Liability Company Partnership Sole Proprietorship Other: C. Due to the civil unrest in Baltimore City, Maryland, that occurred on April, 2015, the Business sustained property loss and damage in the total amount of $. Section II Insurance Information A. Policy Information 1. At the time the property loss and damage was incurred (select one): The Business had insurance to cover the loss incurred under the following type of policy (select all that apply): General Business Liability (CGL) Property Umbrella / Excess Other: The Business had no insurance to cover the loss incurred. 2. If the Business had insurance, please provide the following information: Name of Insurance Company: Policy Number: Insurer s Address: Amount of Coverage: Insurer s Phone Number: Agent s Name: Agent s Phone Number: B. Claim Information 1. As a result of the damage and loss incurred, the Business (select one): Has submitted an insurance claim under the above-referenced policy. Has not submitted an insurance claim because. 3

4 2. If an insurance claim has been submitted, please provide the following information: Claim Number: Date Submitted: Section III Request for Funds A. I am requesting funds from Baltimore Development Corporation ( BDC ) on behalf of the Business in the amount of $ because (please select one and attach a copy of all relevant documentation): The insurance company denied the above-referenced claim entirely. The insurance company only covered a portion of the above-referenced claim for the loss incurred in the amount of $. The Business had no insurance to cover the loss incurred. Other: B. I confirm and attest as follows (please read and initial next to each statement): The application for funds I have submitted to BDC for reimbursement was due to the property loss and damage sustained by the Business as a direct result of the civil unrest indicated above. The property loss and damage items listed in the application represent an immediate, out-of-pocket expense to me, the undersigned, as an owner of the Business. I agree that if all or any portion of the funds received from BDC is subsequently recovered from insurance or any other source, I will immediately reimburse BDC for all or the portion of the funds received from that source. I further agree and understand that if any of the information provided in this Affidavit of Property Loss is not true and correct, I will be held personally liable to reimburse BDC for the funds received. I SOLEMNLY AFFIRM, under penalties of perjury and upon personal knowledge that the foregoing statements are true and correct. BUSINESS NAME: Signature Name: Title: Date: 4

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6 Baltimore Business Recovery Loan Fund Criteria The Baltimore Business Recovery Loan Fund will provide loans convertible to grants of up to $35,000 to small businesses in an expedited manner to help in the recovery efforts. The Baltimore Development Corporation will manage and operate the loan program. Through the program, small businesses in the affected time period outlined below will be eligible to receive loans convertible to grants of up to $35,000, subject to the availability of funds provided the business receiving the assistance meets the following: Experienced direct physical damage to real property or personal property as a result of the unrest that occurred in Baltimore City, Maryland between Saturday, April 25, 2015 and Sunday, May 3, If a corporation- A copy of the 2014 Federal Business Tax return. If a 2014 business tax return has not been filed, the business must provide a copy of an extension and a copy of a 2013 business tax return if the business was in operation in If a Sole Proprietor- A copy of the 2014 Personal Federal Tax Return to include Schedule C. If a 2014 Personal Federal Tax Return has not been filed, a copy of an extension has to be provided, and a copy of the 2013 Personal Federal Tax Return with a schedule C is required if the business operated in If a single member Limited Liability Corporation- A copy of the 2014 Personal Federal Tax Return to include Schedule C. If a 2014 Personal Federal Tax Return has not been filed, a copy of an extension has to be provided and a copy of the 2013 Personal Federal Tax Return with a schedule C is required if the business operated in All applicants A copy of the 2014 Personal Federal Tax Return. If a 2014 Personal Federal Tax Return has not been filed, a copy of an extension for 2014 is required and a copy of the 2013 Personal Federal Tax Return. If not fully covered by insurance for the loss, a letter or from your insurance broker/agent or insurance company stating the amount of your loss and what is and isn t covered and the dollar amounts If not covered by insurance for the loss, an itemized statement of the losses incurred certified by the owner of the business with values, and an affidavit of no insurance. Copy of the current business license. Police report of the incident. Photographs before and after if available. For the conversion from loan to grant the business must have remained open for a period of two years. Two years is defined as the 24 th month from the date of the loan closing. At that time the loan would be fully forgiven. Applicant will be informed of potential tax issues as it relates to forgiveness. Eligibility: Any legally operated business that was in operation at the time of the unrest and sustained damage as described above is eligible for funding except for businesses that sell liquor or other alcoholic beverages. As the Baltimore Business Recovery Loan Fund consists of private donations, BDC will respect funders requests that their contributions do not go to any businesses that sell liquor or other alcoholic beverages. 6

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8 - Template for Borrower Review - FUNDING AGREEMENT BY AND BETWEEN THE CITY OF BALTIMORE DEVELOPMENT CORPORATION AND [ ] THIS FUNDING AGREEMENT (the Agreement ), made this day of 2015, by and between THE CITY OF BALTIMORE DEVELOPMENT CORPORATION ( BDC ), a corporation of the State of Maryland with an address of 36 South Charles Street, Baltimore, Maryland 21202, and [ ] [an individual residing in the State of Maryland] [a corporation/limited liability company/partnership] of the State of Maryland with an address of [ ] Street, Baltimore, Maryland 212 ( Grantee ). BACKGROUND RECITALS 1. BDC has obtained funds (the "Recovery Fund") to facilitate the recovery by businesses from damages incurred in connection with the disturbances of May 2015 (the "Events"). 2. Grantee has experienced the [damages/costs/losses] described in its application (the "Damages") as a result of or from the Events. 3. BDC has determined that the Damages from the Events qualify Grantee for a grant that need not be repaid (the "Forgivable Grant") in the event that Grantee satisfies the conditions listed herewith (the "Conditions"). Among the Conditions will be a requirement that Grantee's business remains open and operating for at least two (2) years (the "Operating Period") from the date funds are first provided to Grantee (the "Funding Date"). Loan to be forgiven at a rate of 1/24 th per month. 4. BDC has determined that Grantee is entitled to a Forgivable Grant in the amount of $. 5. Grantee commits to BDC to use the Forgivable Grant for the purposes set forth in its application (the "Authorized Purposes"). NOW, THEREFORE, the parties hereby agree as follows: A. BDC will provide the Forgivable Grant upon presentation of evidence, through a cost proposal, invoice or other acceptable document, that funds are immediately needed for the Authorized Purposes. BDC's funding can occur in one or more payments, depending on Grantee's needs and the Authorized Purposes. B. Grantee promises to use the Forgivable Grant solely for the Authorized Purposes and to complete the Authorized Purposes (or make all the necessary payments towards the Authorized Purposes) within the time requirements. Upon completing the Authorized Purposes, Grantee will provide BDC with evidence, acceptable to BDC, that the Forgivable Grant was used solely for the Authorized Purposes. Upon such presentation, and after the end of the Operating Period, any obligation to repay the Forgivable Grant will be waived in writing by BDC. 8

9 C. If the Conditions are not satisfied, Grantee agrees to repay to BDC, at the address noted above, the full amount of the Forgivable Grant. However, if the only Condition not fully satisfied is the twenty-four month Operating Period, BDC will nonetheless forgive 1/24 th of the Forgivable Grant for each month that Grantee operates its business after the Funding Date. D. Grantee certifies that the Damages were incurred as a result of or from the Events. E. BDC will try to assist Grantee in securing any permits, licenses or approvals required to perform the Authorized Purposes, and to advise Grantee of any applicable laws known to BDC that must be complied with in performing the Authorized Purposes. However, Grantee's obligation to perform in accordance with this Agreement will remain regardless of BDC's degree of success in such efforts. In any event, Grantee will comply with all applicable laws. F. Grantee authorizes BDC to make such disclosures are BDC determines are appropriate in connection with the Recovery Fund, including disclosure of Grantee as a recipient of the Forgivable Grant. G. If determined by a review that BDC overpaid Grantee, Grantee shall be responsible for repayment of any and all overpayments. Grantee agrees to indemnify BDC for any injuries to persons or damage to property resulting from the performance of the Authorized Purposes. H. Grantee will use good faith efforts to employ residents of the City of Baltimore, if individuals are hired, or companies based in Baltimore, if firms are used, in connection with the performance of the Authorized Purposes. I. Grantee will not discriminate on any basis in hiring employees or selecting firms to perform the Authorized Purposes. Grantee understands that BDC is relying on the accuracy of the information provided, both on the application and in any documentation of the use of moneys, and that knowing misinformation will give BDC the right to forfeit any prior forgiveness and to seek other available legal action. J. Maryland law will govern the implementation of this Agreement. K. This Agreement is not assignable. [remainder of page intentionally left blank] 9

10 IN WITNESS WHEREOF, the parties hereto have effected this Agreement and have caused the respective corporate seals to be affixed hereto: ATTEST: THE CITY OF BALTIMORE DEVELOPMENT CORPORATION BY: ATTEST: [GRANTEE]. BY: (SEAL) 10