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Purpose of this form:This form is to be completed by the authorized representative of the Applicant and submitted to your SBA Participating Lender. Submission ofthe requested information is required to make a determination regarding eligibility for financial assistance. Failure to submit the informationwould affect that determination.
Instructions for completing this form:With respect to "purpose of the loan," payroll costs consist of compensation to employees (whose principal place of residence is the UnitedStates) in the form of salary, wages, commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tipsor, in the absence of such records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental, family, medical, orsick leave; allowance for separation or dismissal; payment for the provision of employee benefits consisting of group health care coverage,including insurance premiums, and retirement; payment of state and local taxes assessed on compensation of employees; and for anindependent contractor or sole proprietor, wage, commissions, income, or net earnings from self-employment or similar compensation.
For purposes of calculating "Average Monthly Payroll," most Applicants will use the average monthly payroll for 2019, excluding costs over$100,000 on an annualized basis for each employee. For seasonal businesses, the Applicant may elect to instead use average monthly payrollfor the time period between February 15, 2019 and June 30, 2019, excluding costs over $100,000 on an annualized basis for each employee.For new businesses, average monthly payroll may be calculated using the time period from January 1, 2020 to February 29, 2020, excludingcosts over $100,000 on an annualized basis for each employee.
If Applicant is refinancing an Economic Injury Disaster Loan (EIDL): Add the outstanding amount of an EIDL made between January 31, 2020and April 3, 2020, less the amount of any "advance" under an EIDL COVID-19 loan, to Loan Request as indicated on the form.
All parties listed below are considered owners of the Applicant as defined in 13 CFR § 120.10, as well as "principals":
Paperwork Reduction Act – You are not required to respond to this collection of information unless it displays a currently valid OMBControl Number. The estimated time for completing this application, including gathering data needed, is 8 minutes. Comments about this timeor the information requested should be sent to: Small Business Administration, Director, Records Management Division, 409 3rd St., SW,Washington DC 20416., and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Washington DC20503.
Privacy Act (5 U.S.C. 552a) – Under the provisions of the Privacy Act, you are not required to provide your social security number. Failure toprovide your social security number may not affect any right, benefit or privilege to which you are entitled. (But see Debt Collection Noticeregarding taxpayer identification number below.) Disclosures of name and other personal identifiers are required to provide SBA withsufficient information to make a character determination. When evaluating character, SBA considers the person’s integrity, candor, anddisposition toward criminal actions. Additionally, SBA is specifically authorized to verify your criminal history, or lack thereof, pursuant tosection 7(a)(1)(B), 15 USC Section 636(a)(1)(B) of the Small Business Act (the Act).
Disclosure of Information – Requests for information about another party may be denied unless SBA has the written permission of theindividual to release the information to the requestor or unless the information is subject to disclosure under the Freedom of Information Act.The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use is the disclosure ofinformation maintained in SBA’s system of records when this information indicates a violation or potential violation of law, whether civil,criminal, or administrative in nature. Specifically, SBA may refer the information to the appropriate agency, whether Federal, State, local orforeign, 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 but only to the extent the information is relevant tothe requesting agencies' function. See, 74 F.R. 14890 (2009), and as amended from time to time for additional background and other routineuses. In addition, the CARES Act, requires SBA to register every loan made under the Paycheck Protection Act using the TaxpayerIdentification Number (TIN) assigned to the borrower.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) – SBA must obtain your taxpayeridentification number when you apply for a loan. If you receive a loan, and do not make payments as they come due, SBA may: (1) report thestatus of your loan(s) to credit bureaus, (2) hire a collection agency to collect your loan, (3) offset your income tax refund or other amountsdue to you from the Federal Government, (4) suspend or debar you or your company from doing business with the Federal Government, (5)refer your loan to the Department of Justice, or (6) foreclose on collateral or take other action permitted in the loan instruments.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) – The Right to Financial Privacy Act of 1978, grants SBA access rights tofinancial records held by financial institutions that are or have been doing business with you or your business including any financialinstitutions participating in a loan or loan guaranty. SBA is only required provide a certificate of its compliance with the Act to a financialinstitution in connection with its first request for access to your financial records. SBA's access rights continue for the term of any approvedloan guaranty agreement. SBA is also authorized to transfer to another Government authority any financial records concerning an approvedloan or loan guarantee, as necessary to process, service or foreclose on a loan guaranty or collect on a defaulted loan guaranty.
Freedom of Information Act (5 U.S.C. 552) – Subject to certain exceptions, SBA must supply information reflected in agency files andrecords to a person requesting it. Information about approved loans that will be automatically released includes, among other things, statisticson our loan programs (individual borrowers are not identified in the statistics) and other information such as the names of the borrowers (andtheir officers, directors, stockholders or partners), the collateral pledged to secure the loan, the amount of the loan, its purpose in general termsand the maturity. Proprietary data on a borrower would not routinely be made available to third parties. All requests under this Act are to beaddressed to the nearest SBA office and be identified as a Freedom of Information request.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.) – The Occupational Safety and Health Administration (OSHA) can requirebusinesses to modify facilities and procedures to protect employees. Businesses that do not comply may be fined, forced to cease operations,or prevented from starting operations. Signing this form is certification that the applicant, to the best of its knowledge, is in compliance withthe applicable OSHA requirements, and will remain in compliance during the life of the loan.
Civil Rights (13 C.F.R. 112, 113, 117) – All businesses receiving SBA financial assistance must agree not to discriminate in any businesspractice, including employment practices and services to the public on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117 ofSBA Regulations. All borrowers must display the "Equal Employment Opportunity Poster" prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691) – Creditors are prohibited from discriminating against credit applicants on the basis of race,color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into a binding contract); because allor part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any rightunder the Consumer Credit Protection Act.
Debarment and Suspension Executive Order 12549; (2 CFR Part 180 and Part 2700) – By submitting this loan application, you certifythat neither the Applicant or any owner of the Applicant have within the past three years been: (a) debarred, suspended, declared ineligible orvoluntarily excluded from participation in a transaction by any Federal Agency; (b) formally proposed for debarment, with a finaldetermination still pending; (c) indicted, convicted, or had a civil judgment rendered against you for any of the offenses listed in theregulations or (d) delinquent on any amounts owed to the U.S. Government or its instrumentalities as of the date of execution of thiscertification.
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California loans made pursuant to the California Financing Law, Division 9 (commencing with Section 22000) of the Finance Code. All such loans made through Lendio Partners, LLC, a wholly-owned subsidiary of Lendio, Inc. and a licensed finance lender/broker, California Financing Law License No. 60DBO-44694.