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1.
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Business Name: List the full legal name of the applicant for financial assistance.
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2.
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Address: Mailing address where correspondence should be sent. If different
from the applicant location, so indicate.
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3.
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Registered Agent: Provide the registered agent’s name and address.
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4.
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Contact Person: If appropriate, include title
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5.
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Borrower(s): If other than the Business; list the individual(s), partnership
or holding company.
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6.
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Project Location: Give the location where financing will be used. The municipality
is the jurisdiction to whom property taxes are paid.
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7.
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Nature of Business: Give a complete, but concise, description of what the
business does (e.g. restaurant, machine tool, etc.) Do not forget the Federal Employer
ID # and NACIS Code.
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8-9.
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Form of Organization and Ownership: Check appropriate box.
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10.
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Ownership: If not practical to list every business owner, include owners
holding 20% or more of the business. If ownership of the borrower is different from
the business, please list on a separate sheet the owners of the borrower. Minority
or woman ownership must be 51% to be considered for this status. (“Minority” includes
a variety of categories such as racial, ethnic, gender and disability status. Check
with the Prince George’s Office of Central Services staff to be sure.)
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11.
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Gross Sales/Receipts: Gross/Sales receipts of the business during the last
calendar year.
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12.
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Assistance Requested:
- A. Amount of Financial Assistance Requested: Specify amount and nature of
assistance, i.e. loan, grant, etc.
- B. Use of Funds: Identify specific use of EDI funds. For example, relocation,
expansion, remodeling, façade improvement, etc.
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13.
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Project Description: Describe the project for which funding is being requested
(i.e., type of equipment to be purchased, nature of inventory and uses for working
capital). For a building, include address, acres of land, building's square feet,
size of any building addition, current zoning, and map of the site. List any tenants.
Timeline for the project. If project involves refinancing, describe who will be
refinanced and the purpose for the loan. Please attach a separate sheet if necessary.
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14.
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Project Costs: Give best estimate.
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15.
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Source of Funds: In many cases, the EDI funds will not be the primary source
of funds. Be sure to identify other sources of funds to complete the project. Total
sources of funds should equal total project costs. For some projects, a match will
be required.
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16.
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Conventional Financing: Outline the amount and terms of any funds from conventional
sources that are available to fund all, or a portion of the project. If applicable,
indicate reasons for denial.
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17.
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Receipt of Prior Prince George’s County, Maryland Financing Assistance: Indicate
if your company has received or defaulted on any prior financial assistance from
the County.
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18.
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Community Benefit Assessment: Provide a statement regarding how the proposed
project will benefit Prince George’s County, Maryland per Subtitle 10, Section 10.284
of the Prince George’s County Code - Economic Development Incentive Fund (CB-4-2011)
and the immediate impacted community. Quantify impact where possible.
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19.
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Prince George’s County, Maryland Employment: Please provide current and projected
employment for the project. The projected employment is the anticipated number of
employees working at the project within 3 years.
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20.
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Environmental Impact: Do you have any outstanding orders or citations from
the Prince George’s County Department of Environmental Resources, Maryland Department
of Environment or federal Environmental Protection Agency?
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21.
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Required documents:
- Pre-Qualification Review:
- A. Signed Application
- B. Personal financial statements of owners of 20% or more of the company.
Sign and date in blue ink.
- C. Confidentiality Statement
- D. Current Credit Report & Credit Score - no more than six months old.
- Credit and Financial Review:
- E. Business Plan, Executive Summary, Capability Statement: This should include
a complete description of the firm, its products and services, the project and an
explanation of the use of EDI funds. Include a current copy of the firm's business
plan if the applicant has been in business less than three (3) years; or Executive
Summary if the applicant has been in business more than three (3) years; and capability
statement.
- F. Articles of Incorporation & Organization if LLC
- G. Certificate of Good Standing:
- H. US Corporate or Partnership Tax Returns: as applicable with all attachments for past 3 years.
- I. Resume of Company Owner(s) & Management Team
- J. Disclosure of Interested Parties Form
- K. Schedule of related affiliated companies
- L. If the project involves the purchase of a business, please provide the following:
- Purchase Agreement or memorandum between the parties.
- Current balance sheet of business being acquired.
- Appraisal, or estimate of value, of seller's real estate and equipment.
- M. Business Indebtedness Form
- N. Summary of Collateral
- O. 4506-T-Tax Return Verifications
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22.
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Public Disclosure: Prince George’s County, Maryland may be required by law
to inform the general public about the use of EDI funds prior to final approval
and closing of deal. Please provide a statement if the release of this information
would be considered a disclosure of confidential or proprietary information, or
trade secret.
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23-26.
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Disclosures: Unpaid Taxes, Pending Litigation, Declaration of Bankruptcy, Judgments,
Lien, or
Defaults: Provide accurate and complete information.
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