MIAMi BAYSIDE FOUNDATION
---Advancing MIami's economy Ihrough !he support of minority businesses
Kathleen Murphy Executive Director
25 SE 2nd Ave., Ste 240 Miami, FL 33131 T: 3OS-379-701O ><204 M: 305-710-5433 KathleenOMiamiBaysideFoWldation.org www.miamibaysideroundation.org
Submitted into the public record in connection with items ~ on 06-09-11 Priscilla A. Thompson City Clerk FOUNDA ION
Adv ndng M~mi's economy through the ~upport of minor it 'i businesses
June 9, 2011 MEDIA CONTACT: Kiskinis Communications, Inc. Melissa Nobles (305) 447-1224
MIAMI BAYSIDE FOUNDATION PRESENTS ENDOWMENT FUNDS TO
FLORIDA INTERNATIONAL UNIVERSITY
The Miami Bayside Foundation will present Florida International University (FlU) with funds toward an endowment and scholarship program in the amount ofmore than $350,000. Celebrating its new partnership with the University, a check presentation is planned for Monday, June 13 at Bayside Marketplace's Marina Stage (401 Biscayne Boulevard) at 3:30 p.m.
With the primary goal of stimulating economic development in the City of Miami, the Miami Bayside Foundation has provided vocational workshops and educational scholarships to minority businesses and students since 1988. Continuing its mission, this donation from the Foundation will provide talented students within the City the resources needed to pursue their academic and professional goals at FlU.
Nearly 50 percent ofall undergraduate students at FlU receive financial aid, and nearly 60 percent ofthose recipients come from families with an annual household income less than $30,000. Students representing the first generation in their families to attend college account for nearly 40 percent of FlU's student body.
"It was vital for the Miami Bayside Foundation's decision to add FlU, Miami's premier public research university, to its list ofpartnering educational institutions," said Nathan Kurland, chairman ofthe Bayside Foundation's scholarship committee. "There's such a need for fmancial assistance in our community."
In providing funds toward an endowment and a First Generation Scholarship program, the Miami Bayside Foundation will assist in preventing highly motivated students with limited resources from being forced to attend only part-time colleges or postpone their education altogether. SUBMIT 0 INTO THE PUBLICRECORD FOR ITEM D5.~ ON 6)/9/ll . •
"The Miami Bayside Foundation believes that in order to advance our community, we need to start at the real center of innovation," said Kurland. "Through education we can truly empower today's entrepreneurs and the aspiring entrepreneurs of tomorrow."
In April, the Miami Bayside Foundation presented $9,000 in scholarships to students enrolled in Miami Dade College's School of Business. The scholarship program is part ofan additional endowment fund created by the Foundation serving Miami Dade College. The fund at Miami Dade College currently totals close to $1 million.
FlU is ranked first in the nation in awarding bachelor's degrees to minorities and has the fastest growing university alumni group in the region.
The Endowment gift of$103,000 created to support City of Miami residents will be matched at 50 percent by the State of Florida, resulting in total funds of$150,000. Also supplemented by matched state funds, the $100,000 gift toward the First Generation Scholarship Fund over 10 years will be matched at 100 percent, resulting in total funds of $200,000. The total impact ofthe endowment and scholarship gifts equal more than $350,000.
The Miami Bayside Foundation, a City of Miami-based non-profit established in 1986, has created and administers a loan program for minority businesses, has established a scholarship fund for minorities studying entrepreneurship and business, and provides technical assistance to community and development organizations in the City ofMiami.
For more information on the Miami Bayside Foundation, call (305) 379-7070, e-mail [email protected] or visit www.miamibaysidefoundation.org.
About Florida International University Foundation, Inc.
Florida International University Foundation, Inc. (FlU Foundation) was established in 1969 to encourage, solicit, receive and administer gifts for scientific, educational and charitable purposes for the advancement of Florida International University and its objectives. It is registered by the State of Florida as a charitable organization and is approved by the U.S. Internal Revenue Service as a tax exempt 501(cX3) organization. The Foundation has also been certified as a Direct Support Organization (DSO) of Florida International University as defined in Florida Statue 1004.28.
The FIU Foundation is a non-profit corporation governed by a Board of Directors, whose members playa significant role in the development of the University as a major educational, cultural and economic resource. Through the involvement of the Directors and their contribution of time, leadership and financial resources, the mission of the University is advanced.
Submitted into the public record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson City Clerk MIAMI DADE COLLEGE MIAMI BAYSID EFOUNDATION MIAMI BAYSIDE FOUNDATION MiamiDade SCHOLARSHIP APPLICATION College 2011-2012
Student Name: ------
Mailing Address: ______~______
Home Phone #: (1...-_-./) ______Work Phone #: ('--_-') ______
MD ID#: ------Campus: ------E-Mail Address: ------
Date ofBirth: ------Sex: Marital Status: ------
Ethnicity: (please cire/e) W B H A I 0 High School Attended: ______
Citizenship: u.s. Citizen_ Perm. Resident: Visa: Other:" - ---- Legal Residence: County: State: ______
Cumulative GPA: Program GPA: ____
Expected Graduation Date: Degree Program: (please cire/e) AA AS BS Other___
Major: ___ - ______
Have you applied for Financial Aid for 2011-2012? (Please circle) Yes No
Are you employed? (Please circle) Yes No
Student Signature Date
MAIL this completed form to: Yadira Cod ina th Due Date: June 30 , 2011 Miami Dade College District Financial Aid Office - Room 1127 11011 S. W. 104th Street Miami, FL 33176 Submitted into the public record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson City Clerk MIAMI BAYSIDE FOUNDATION
MIAMI BAYSIDE FOUNDATION SCHOLARSHIP (UPDATED CRITERIA)
SCHOLARSHIP CRITERIA:
1. A student enrolled in or accepted for admission to Miami Dade College with an interest in business, I'eadership, and/or entrepreneurship. 2. The scholarship is open to a student enrolled in any degree or certificate program. 3. U.S. citizens or permanent residents. 4. Students must be City of Miami residents (please review the attached for further assistance in determining residency). 5. Minorities, as defined in the Florida Statutes S288.703t3). 6. Demonstrated financial need based on federal financial aid standards (must have filed FAFSA for 2011-2012f) 7. A cumulative grade point average of at least 2.5 at the College or, if newly enrolled at the College, at prior institutions attended. 8. Complete a 250 word essay that demonstrates the student's interest in business, leadership, and/or entrepreneurship. 9. The award amount per student will be $1,000 (12 credits or more) or $500 (credits between 6 - 11)
Please Note: If student already applied for 2011-2012, there is no need to re-apply.
SELECTION PROCEDURE:
The final recipients will be chosen principally on the basis of academic performance or potential and the extent of unmet financial need.
th All mailed applications must be postmarked no later than June 30 , 2011 .
Submitted into the public record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson City Clerk
2011-2012 Bayside Foundation Scholarship Application - UPDATED Created by: YMC CITY OF MIAMI L l ~ '"='~ . __COMMISSION DISTRICTS AN D ZIP CODES M\''''!"~--I Ho~rable Mayor Tomas P. Regalado - Citywide ~1=~~r:a;tlrq
C zt,Codes Commluion District & CommiMioner Name 1. \MIre<» (Willy) Goo 2. Marc Samoff 3. Frank Carollo 4. FranCIS Suarez 5. Richattl P Dunn II
C'&lIed ~ Iho c.y of Moa.mi PIan ..ng [loop.rtme'" ~I. · ~25 ' IO I 0 "eqtIMWCOMI.IISSICN DISTRICTS 'cd
Submitted into the public record in connection with items D5.2 on 06-09:-11 Priscilla A. Thompson City Clerk
2011-2012 Bayside Foundation Scholarship Application - UPDATED Created by: YMC Miami Bayside Foundation Announces Minority Scholarship Recipients c;;, IJ . ~ DATE: April 21. 2011 MEDU CONTACr:
Kiskinis Conullunications. Inc.
~I l\lililmi BaYside FoWldation Announces Minoli'" Schollilnllup Recipients FOllndation Selects Nine Alwmi Dade College Stlldents The Miami Bayside Foundation announced the recipients of its scholarship program on 111Ursday. April 21 at a reception on the front steps of Miami Dade College's Wolfson Campus - Building I (300 Northeast S.:cond A\"omue. ~Iiami. FL 33132). Each enrolled in the Miami Dade College School of Business. a total of nine students \Vere selected for the spring 20 I I semester scholarship program, "The Miami Bayside Foundation is proud to foster y'oung entrepreneurs:' said Nathan Kurland. chairman of the Foundation's scholarship conuu.itlee. "It is our mission to encourage young minority students to continue their business education by providing them with the financial resources to make it happen." Students selected for the prestigious award included: Jelfrey Green. ~1ckenz\' Yakntin. PauMte Petit Frere. Jackson Da\'id. ~Iabel Cruz. JelUlifer Nacipucha. Ralph Davis, Juliette ~Iathurin and Lucyla Escoto. Pal1nering with Miam.i Dade College. the Miami Bayside Foundation created a vocational and educational scholarship endowment nmd for minority students. Since its creation. the Foundation has provided grants to more than 80 sUldents and currently has an endowment fund ofclOSe to $1 nUllion. "\Ye are so pkased to ha\'e the ~Iiami Bayside Foundation 's suppoI1:' s:lid Lula Rodriguez. \ice president..-\d\·ancement and E~1ernal Aftairs. "Their generous donation he~)s us ensure that We can conti.nue changing Ii\'es through the opportunity of an education." The r.liami Bayside Foundation. a City of Miami-based Ilonprotit established in 1988. creakd and administers a loan program for minority businesseS. established a scholarship fund for minorities studying entrepreneurship and business. and has programs that pro\'ide technical assistance to minority businesses in the Cit\' of ~Iiami. ~Iiami Dade College is the nation's largest institution ofhigher education with an enrollment of more than 170.000 students. It is also Ihe nation's top producer of associate in arts and science degrees. 111e college's eight campuses and outreach centers ofter more than 300 distinct degree programs including se\'eral baccalaureat~ degrees in ~ducation. public safely. supen'isilln and managem~nt and nursing. In t:,cL its academi.: and wllrk10cce training programs haw sen'ed as nationalmodds of exc~lknce . ~IDC is also renowned for its rich cultural programming. It is home of the Miami Book Fair International Miami International Film Festi\'al the Cultura del Lobo perfol111ing arts series. the National Histori.: Landmark ~Iiami Freedom Tower. a sculpture park and a large art gaUer~' and theater system. ~IDC has serwd nearly 2.000.000 students since it opened its doors in 1960. To see phot()~ from th.: r~cept i oll. \'isil th~ Foundation'S photo gallen·. tv\IAMI HAY IDE FOUNDATION Submitted into the public --- ,- record in connection with i;J 2011 ~liami Bayside Foundation. all rights resen'ed items 05.2 on 06-09-11 liami Wllb~i t e D.:sign. ECt'mmerce De\'elopment & Web Design by ~Iiami Web D.:sign Priscilla A. Thompson City Clerk (305) 379-7070 25 SE 2nd Avenue. Suite 240 Miami.FL 33131 Programs In addition to its loan program. the Miami Bayside Foundation provides valuable business tools and resources such as counseling and training in business development and management and other related services. through partnerships with local conununity organizations engaged in economic deYelopment. Announcing a pal1nership in 2011. the Miami Bayside Foundation teamed up "lth the Miami-Dade chapter ofSCORE. the premier resource for small bu~iness advice and mentoring in America. This partnership allows candidates and future minority business O\\l1erS recommended by Miami Bayside Foundation access to all ofSCORE's services tree ofcharge. Tlus includes one-oil-one mentoring as \\1::11 tl'ee registration to their ongoing workshop programs otlering the tools needed by small business O"l1ers. SCORE Miami matches startup business owners with more than 65 working and retired executives who donate their time and expertise as mentors. They oiler contidential small business counseling to help start and build your business - from plamung. to startup. to success. The Mianu Bayside Foundation allows tor any qualified candidate to receive the organization's resources free ofcharge. including: • Group worksbops oUering specialized training on weeknights and Saturdays • Online courses and podcasts on va rious topics ayailable 24 hours a day. seven daysa week • One-on-one business counseling \\lth experts in a variety of tields If you are interested in participating in the Miami Bayside Foundation partnership with SCORE Miami. and receiving such services tree of charge. please call (305) 379-7070 or e-mail [email protected].. To tind out more about SCORE Miami. visil www.scoremiami.org. To view a list ofupcoming SCORE Miami workshops. click here for their calendar. MIAMI HAYSIDE FOUNDATION Submitted into the public record in connection with 2011 Miami Bayside Foundation. all rights reserved - iC' - items 05.2 on 06-09-11 Miami Website Design. Ecommerce Development & Web Design by Miami Web Design Priscilla A. Thompson City Clerk MIAMI BAYSIDE FOUNDATION Advancing economic development in the Oty of Miami through the support of minority businesses 2S SE 2nd Avenue Su ite 240, M iami, Fl33131 Board of Directors Chair Benny Carmona Bob Powers Senior Vice President/Bank Lending Division Retired Total Bank 565 NE 66 Street 2720 Coral Way, 2nd floor Miami, FL 33138 Miami, Florida 33145 305-299-0052 (305) 476-6399 bob [email protected] [email protected] Vice-Chair Jeff Cazeau Pamela Weller Kleiner Cazeau Senior General Manager 18305 Biscayne Blvd., Ste. 302 Bayside Marketplace Aventura, Florida 33160 Bayside Boulevard, Suite 106 (305) 517-1392 ext 102 Miami, FL 33132 [email protected] 305-577-3344 x7010 [email protected] Luis Cuervo Executive Director Treasurer CAMACOL Loan Fund Program Josie Correa 1401 West Flagler Street Executive Director Miami, FL 33135 Downtown Miami Partnership, Inc. 305-642-3870 nd 25 SE 2 Avenue, Suite 240 [email protected] Miami, FL 33131 305-632-1014 Bill Diggs [email protected] President & Chief Executive Officer Miami Dade Chamber of Commerce Secretary 11380 NW 27th Avenue, Suite 1328 Maria Korge Miami FI33167 Managing Partner 305-751-8648 Korge & Co. [email protected] 459 SW 19th Road Miami, FL 33129 Nicole E. Ewan 305-858-2270 Record Systems Coordinator [email protected] City of Miami 3500 Pan American Drive Trustees Miami, FL 33133 Rolando Aedo 786-973-7787 Executive Vice President/Chief Marketing Officer [email protected] Greater Miami Convention & Visitors Bureau 701 Brickell Avenue, Suite 2700 Nathan Kurland Miami, Florida USA 33131 Licensed Realtor 305-539-3090 3121 Commodore Plaza [email protected] Coconut Grove, FL 33133 215-776-1038 [email protected] Submitted into the public record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson MBF Board of Directors (page 2) Beatrice Louissant Chief Executive Officer South Fl Minority Supplier Development Council 9499 NE 22nd Avenue, Suite 201 Miami, Fl33138 305-762-6151 [email protected] louis McMillian Global Investment Realty 235 NE 26th Street Miami, Fl33131 305-469-8400 [email protected] Pablo Perez-Clsneros Retired 1420 Brickell Bay Drive Miami, Fl33131 305-373-8104 [email protected] Non-Board Committee Members Adam Dunshee Retired 500 NE 50th Terrace Miami, Fl33137 (303) 725-8098 [email protected] Loan Committee Kathleen O'Neil Retired 3301 NE 5th Avenue Apt 310 Miami, Fl33137 786-514-2111 [email protected] Finance & Audit Committee June 2011 Submitted into the public record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson City Clerk Miami Bayside Foundation, Inc. 25 SE 2nd Avenue, Suite 240 Miami, FL 33131 305-379-7070 fax: 305-379-7222 www.miamibaysidefoundation.org LOAN APPLICATION REQUIREMENTS FORMS ENCLOSED TO BE FILLED OUT AND SIGNED BY ALL OWNERS AND/OR PRINCIPALS 1. _ Business Loan Application 2. Personal Financial Statement 3. _ Statement of Personal History 4. _ Authorization for Services and Waiver of Liability 5. _ Plan for Compliance with Job Creation and Retention 6. _ Inventory of Fixtures and Equipment Owned 7. Form 4506-T 8. Borrower Authorization to Premium Credit Bureau 9. _ Credit Card Authorization for Credit Report INFORMATION REQUESTED 1. _ Business Financial Statements for the last three (3) fiscal years. 2. _ Corporate Tax Returns (federal income tax) for the last three (3) years. 3. _ Personal income Tax Return filed for the last three (3) years. 4. _ Current Financial Statement of Business with supporting bank statements 5. Business Plan 6. _ Personal Resume of all principals. 7. _ Monthly Profit and Loss estimated results for one (1) year, and annual projections for the next four (4) years, for a total of a five (5) years plan. 8. _ Monthly Cash Flow estimated results for one (1) year, and Annual Projections for the next four (4) years, for a total of a five (5) year plan. 9. _ List of Fixtures and Equipment to be purchased accompanied by pro-form invoices. 10. _ Copy of Lease or Letter of Intent to Lease. 11. _ Copy of business documents: Partnership Agreements, Articles of Incorporation, By Laws, Certificate of Good Standing, etc. 12. _ Copy of Business Certificate of Use, Occupational License (City and County), State license as appropriate. OTHER INFORMATION THAT WILL BE REQUESTED AFTER APPROVAL 1. _ Copy of Warranty Deeds, Owner's Title Insurance Policy and Survey of al\ Real Estate owned by business and/or guarantors and copy of Closing Statements evidencing original purchase. 2. _ Evidence of tax assessment values and any existing appraisals not older than six (6) months. The appraiser must be State Certified and have been licensed for at least two (2) years. 3. _ Evidence of existing mortgage balances and copy of corresponding documents. State License as appropriate. 4. _ Written evidence of updated insurance coverage on property owned. 5. _ Minority Business Certification from one ofthe following agencies: NMBC, SFMSDC, Disadvantaged Business Enterprise (Miami-Dade County), 8A (SBA), or MBE (State of Florida). BUSINESS LOAN APPLICATION BUSINESS INFORMATION Business Name: ______Business Address as stated on Occupational License: ComactPe~on: ______ Telephone: ______ Sole Proprieto~hip ( Partne~hip ( ) Corporation ( Other ( ) Ownership Distribution: (list stockholders, partners, and owner names) Name: ______Title: ______#of y~ ___ %__ 55#______Address: ______ Name: ______Title: ______#of y~ _ __ % __55#______Address: ______ Name: ______Title: ______#of y~ ___ % _ _ 55#______Address: ______ Type of Business: ______D, ate Established: ______ Present Number of Employees: ______Proposed Number of Employees after loan: ______ Years at present location: ( ) Own ) Lease FINANCIAL INFORMATION Business Bank Account: ______Account Number: ______ Have you requested previous government financing? ( ) Yes ( ) No Loan #: Agency's Name: Original Original loan Present Balance Repayment Terms Status: Date Amount ! I I I Business Debts and Credit Relationships - Include Mortgages Payable, Contracts. Notes, Business Debts, etc. Agency's Name: Original Original loan Present Balance Repayment Terms Security: Date Amount I I I Submitted into the public record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson pa!:le 2 of 12 City Clerk LOAN REQUEST Specific Loan Purpose (Check all that apply) EXPLAIN ( ) Working Capital $,____ ( I Purchase of Inventory $.____ ( ) Purchase of Equipment $____ ( ) Expansion $____ ( ) Other $____ Loan Amount $_0____ Collateral Available (Check all that apply) ( ) All Assets (accounts receivable, inventory, machinery and equipment) $______( ) Specific Equipment (Please attach equipment list) $______( ) Real Estate $______( ) Personal Assets (As described in Personal Financial Statement) $______( ) Other $______Total Collateral $_0______ MISCELLANEOUS INFORMATION Are tax liabilities current? I ) Yes ( , No (If no, explain on a separate sheet) Is the business an endorser, guarantor, or co-maker for any obligation not listed in the financial statements? (,Yes I I No If yes, what is the contingent liability? ______ Has the business or principal owner ever declared bankruptcy? ( ) Yes ( ) No (If yes, provide details on a separate sheet) Is the business a defendant in any lawsuit? ( ) Yes ( ) No Are any of the business assets encumbered by liens or attachments of any type? ( ) Yes ( ) No What ______By whom _~______Amount $______ What ______By whom Amount $,______ 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 Miami Bayside Foundation, Inc. immediately of any material changes in this information. The undersigned authorizes Miami Bayside Foundation, Inc. to contact any bank and trade creditors it deems necessary without further notice, including, but not limited to, Dun & Bradstreet reports or information from any credit reporting agency. Notice to applicant: The purpose of Miami Bayside Foundation, Inc. is to create and administer a loan fund to minority business enterprises in the City of Miami. The Lender reserves the right to recall the loan if these requirements are not met. Applicant Signature: ______Date: ______~ Applicant Name and Title: ______ Appi'icant Signature: ______Date: ______ Applicant Name and Title: ______ Submitted into the public record in connection with Page 2 of Business loan Application items ~ on 06-09-11 Priscilla A. Thompson City Clerk P8Qe 3 of 12 Personal Financial Statement (This form is to be filled out by each Applicant) Borrower SECTION 1-PERSONAL INFORMATION SDouse Borrower's Name: Spouse's Name 55#: IHome Phone: Date of Birth: 55#: Home Phone: Date of Birth: ( ) Married ( ) Unmarried Place of Birth: Place of Birth: ( ) Separated Driver license Number: Driver license Number: Present Address (street, city, state, zip) ( I own ( ) rent _# yrs. Present Address (street, city, state, zip) ( ) own I ) rent _# yrs. If residing at present address for less than two years, complete the following Former Address (street, city, state, zip) I ) own ( I rent _# yrs. Former Address (street, city, state, zip) ( .own ( ) rent _# yrs. Nearest relative not living with you. Address: Phone: Relationship: Name: Borrower SECTION 2 - EMPLOYMENT INFORMATION SDouse Name and address of employer: Years on thisjob:__ Name and address of employer: Years on this job:__ Years employed in this Years employed in this line of work:-- line of work:- - Position/Title/Type of Business: Business Phone: Position/Title/Type of Business: Business Phone: If employed for less than two years or if employed in more than one position, fill below: Name and address of employer: Dates (from-to): Name and address of employer: Dates (from-to): Monthly Income: Monthly Income: Position/Title/Type of Business: Business Phone: Position/Title/Type of Business: Business Phone: SECTION 3 - INCOME SECTION 4 - CONTINGENT UABILmES Monthly Inc:ome Borrower Co-Borrower Total Lia bilities Borrower Co-Borrower Total I Salary S S S As endorser or Co S S S 0 , maker I 0 Net Investment S S S I Legal Claims and S S I S i lnc:ome 0 judgments 0 Real Estate Inc:ome $ S $ Provisions for Fed. S $ S 0 Inc:omeTax 0 Other Inc:ome $ S $ I Other Spedal Debt $ $ $ Desc:ribe: 0 Desc:ribe 0 0 0 Total & cf cf Total & & & Submitted into the public record in connection with -1 items 05.2 on 06-09-11 Priscilla A. Thompson paQe 4 of 12 rit" ("lArk SECTION 5 - ASSETS SECTION 6 -LIABILITIES Cash on Hand & in Banks $ Accounts Payable $ Savings Accounts $ Notes Payable to Banks & others $ Describe in Section 7 IRA & Other Retirement Accounts $ Accounts& Notes Receivables $ Installment Accounts (Auto) $ Monthly Payments Stocks and Bonds $ Describe in Section 8 $ Life Insurance-Cash Surrender Value Installment Accounts (Other) S Complete Section 12 $ Monthly Payments $ Real Estate loan of Ufe Insurance $ Describe in Section 13 $ Mortgage on Real Estate Describe in Section 13 $ Automobile Present value $ Unpaid Taxes Other Personal Property Describe in Section 10 S Describe in Section 9 $ Other Assets I Other liabilities Describe in Section 9 $ Describe in Section 11 $ TOTAL ASSETS $0 TOTAL LIABILITIES $0 NET WORTH $ SECTION 7 - NOTES PAYABLE TO BANKS AND OTHERS Name and Address of Note Original Current Payment Frequency How Secured Holder Balance Balance Amount (monthly, etc.) Type of Collateral SECTION 8 - STOCKS AND BONDS Number of Name of Securities Cost Market Value Date of Total Value Shares Quotation/Exchange Quotation SECTION 9 - OTHER PERSONAL PROPERTY AND OTHER ASSETS (Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment and if delinquent, detail delinquency) SECTION 10 - UNPAID TAXES (Describe in detail as to type, to whom payable, when due, amount, and to what property, if any, a tax lien is attached) SECTION 11 - OTHER LIABILITIES (Describe in detail) Page 2 of Personal Financial Statement palle 5 of 12 SECTION 12 -LIFE INSURANCE HELD (Give face amount and cash surrender value of policies - name of insurance company and beneficiaries) SECTION 13 - REAL ESTATE OWNED (List each parcel separately. Use attachments if necessary) Property A Property B Property C I Type of Property I Address Date purchased I I I Original Cost , Present Market Value Name & Address of Mortgage Holder Mortgage Account Number Mortgage Balance Amount of Monthly Payment SECTION 14- DECLARATIONS Borrower Co-Borrower I Yes I No Yes No a. Are there any outstanding judgments against you? b. Have you ever declared bankruptcy? c. Have you ever had property foreclosed upon or given title or deed in lieu thereof? , d. Are you party to a lawsuit? e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer oftitle in lieu of foreclosure, or judgment (this would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured home loans, any mortgage, financial obligation, bond, or loan guarantee)? f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? SECTION 15 - ACKNOWLEDGEMENT AND AGREEMENT I/We authorize Miami Bayside Foundation, Inc. to verify the accuracy of statements made and to determine my creditworthiness. I/We herein give authorization to the credit-reporting agency of your choice to deliver a credit report about my person to the interested party. I understand that I hereby waive any privileges I may have regarding the requested information to release it to the interested party. The requested information will be used in reference to my employment, banking, c,edit and residence as applicable and to give this information to Miami Bayside Foundation, Inc. I/We understand that the information from Equifax, TRW, and Merchants Credit Bureau. Its officers, employees, agents or suppliers shall not be liable to the agency, consumer for any claim, injury or damages upon furnishing such credit information. The credit Reporting Agency acts only as a service agent on the client's behalf to obtain a credit report of the consumer. A copy of this form may be used in lieu of the original. I/We certify the above and the statements contained in the attachments are true and accurate as of the stated date. These information and statements are made for the purpose of obtaining a loan and I/We acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liabilities and/or criminal penaltiesl, including, but not limited to, fine, imprisonment or both under the provisions of Title 18, United States Code. Section 1001. et seq and liability for monetary damages to Miami Bayside Foundation, Inc., its agents, successors and assigns, and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made in this application. Applicant's Signature: Date: Spouse's Signature: Date: Submitted into the public record in connection with items 05.2 on 06-09-11 Page 3 of Personal Financial Statement Priscilla A. Thompson City Clerk paQe 6 of 12 Statement of Personal History (This form to be filled out by each Applicant) Last Name:______First Name:______Middle Name:______ U.S. Citizen ( ) Yes ( ) No If yes, documented by (please give the number of one of the following documents): Birth Certificate: ______ Passport: ______ Certificate of Naturalization: ______ If no, give Alien Registration Number: ______ Please attach a copy of document chosen. Give the percentage of ownership or stock owned or to be owned in the small business concern: __% Be sure to answer the following three questions correctly because they are important. The fact that you have an arrest or conviction record will not necessarily disqualify you, but an incorrect answer will probably cause your application to be turned down. Are you presently under indictment, on parole or on probation? ( ) Yes ( I No If yes, provide details in an attachment. List name(s) under which held, if applicable. Have you ever been charged with or arrested for any criminal offense other than a minor vehicle violation? ( ) Yes , ) No If yes, provide details in an attachment. List name(s) under which held, if applicable. Provide three personal references: Name:_-=______Phone: ______ Name: ______Phone: ______ Name: ______Phone: ______ The information on this form will be used in connection with an investigation of your character. Any information you wish to submit that you feel will expedite this investigation, should be set forth. Applicant Name: ______Date: ______ Submitted into the public Applicant Signature: ______record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson City Clerk paAe 7 of 12 AUTHORIZATION FOR SERVICES AND WAIVER OF LIABILITY The Applicant on behalf of himself/herself (or corporation or _~______-" a partnership) hereby requests Miami Bayside Foundation, Inc. to provide financial services. To assist Miami Bayside Foundation, Inc in providing said services, the Applicant agrees to furnish all information and documentation requested by Miami Bayside Foundation, Inc. and certifies that any information, documentation, and representations provided to Miami Bayside Foundation, Inc. will be true and correct. The Applicant agrees that any documents provided to Miami Bayside Foundation, Inc. will become the property of Miami Bayside Foundation. All information and data furnished by the Applicant will be treated as confidential provided that the Applicant authorizes Miami Bayside Foundation, Inc. and/or its affiliates, agents, and representatives to furnish information and data as necessary to local financial institutions in connection with related loans. The Applicant further agrees that Miami Bayside Foundation, Inc. may release such information whenever required by law, whether pursuant to a statutory provision through judicial or administrative order, or by legal proceeds. The Applicant hereby releases Miami Bayside Foundation, Inc., its officers, directors, employees, agents, and independent contractors which it employs (named "Protected Parties") from any and all damage, claims, demands, and causes of action which the Applicant has or may have in the future against the Protected Parties by reason of any occurrences, including without limitation damages, injuries, and loses of any type or manner arising from any services which the Protected Parties provide or fail to provide under this authorization, including the release of information deemed confidential. The Applicant hereby agrees to indemnify and hold harmless the Protected Parties from any and all damages, claims, demands and causes of actions, including, but not limited to, amounts paid upon judgments, attorney's fees, cost and amounts paid in settlement, reasonably incurred in connection with the defense or settlement of any claim, action, sort of proceedings in which any of the Protected Parties may be involved by virtue of services they provide or fail to provide on behalf of the Applicant pursuant to this authorization. The Applicant further agrees that in conjunction with this indemnification, the Applicant shall defend the Protected Parties at its own expense, specially including, without limitation attorney's fees, court costs, expert's fees. Investigation fees and expenses; provided however, that any counsel chosen by the Applicant must be acceptable to the Protected Parties involved in the particular litigation. It is understood that either Miami Bayside Foundation, Inc. or the Applicant may terminate the services provided hereunder at any time. It is further acknowledges that Miami Bayside Foundation, Inc. will provide the services as time permits. The Applicant clearly understands that in the event that Miami Bayside Foundation, Inc. issues a Commitment to lend and it is executed by the Applicant, the Applicant agrees to pay a fee of 1% of the loan amount to cover closing costs and attorney's fees. RIGHT TO FINANCIAL PRIVACY ACT OF 1987 This act was designed to protect the right to financial privacy. This is a notice to you, as required by the Right to Financial Privacy Act of 1978 of Miami Bayside Foundation, Inc.'s access right to financial records held by financial institutions that are or have been doing business with you, or your business, including any financial institutions participating in this loan, or loan guarantee in connection with this loan application. The Applicant further agrees to give Miami Bayside Foundation, Inc. access right continuously for the term of the approved loan without further notice as long as Miami Bayside Foundation, Inc. retains any interest in the loan. The Applicant further agrees to wave all rights derived from this Act and authorizes Miami Bayside Foundation, Inc. to use or transfer to the Government and all those financial institutions involved in this loan, all financial records and to collect on a defaulted loan, or loan guaranty. The Applicant further agrees to authorize Miami Bayside Foundation, Inc. to advertise the approval of this loan in its outreach activities. No other financial records will be released by Miami Bayside Foundation, Inc., except as required or permitted by law. ACKNOWLEDGE I (We) certify that I (We) have read and accept this m=notice and that I (We) have been given a copy of it. I (We) certify that the information contained in this form and all other statements and attachments to it, business and personal, pertaining to this case to be true and accurate. Date: Signature: Submitted into the public Name: Title: record in connection with Date: Signature: items 05.2 on 06-09-11 Priscilla A. Thompson Name: Title: City Clerk paQe 8 of 12 Submitted into the public record in connection with BUSINESS PLAN FOR COMPLIANCE items 05.2 on 06-09-11 WITH JOB CREATION AND RETENTION Priscilla A. Thompson City Clerk Business Name: ______ A. Full Time Employees at present: ___ B. Projected Full Time Employees within two years from loan approval: ___ C. Total Number of Jobs Created (A - B): ___ List of Current Employees (Use separate sheet if necessary) Name: Social Security Family Size Annual Position Hrs per Number Salary week: I I Projected Employees (Use separate sheet if necessary) Name: Social Security Family Size Annual Position Hrs per Number Salary week: SkilljTrainlng required for new positions (use separate sheet If necessary) Job Title: Type ofTest Education License(s) Vrs of Experience Other Requirements Required Required Required Required I I I, I I COMPLIANCE ACTION PLAN Please describe which actions will be taken by the business to ensure that low and moderate income persons will receive first consideration for the jobs to be created. I (WE) CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM IS TRUE AND ACCURATE Applicant's Name: ______ Applicant's Signature: ______Date: ______ Applicant's Name: ______ Applicant's Signature: ______Date: ______ DSQe 9 of 12 INVENTORY OF FIXTURES AND EQUIPMENT OWNED COMPANYNAME: ______~------______ Description Serial Number Year Condition Estimated Purchased (new, fair, needs Current Value repair, etc.) I I I I " Date: ______Submitted into the public record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson SIGNATURE: .______City Clerk paQe 10 of 12 Submitted into the public record in connection with Fcrm 4506·T Request for Transcript of Tax Return items 05.2 on 06-09-11 Priscilla A. Thompson (Rev. January 2010) City Clerk Department of the Treasury ~ Request may be rejected if the fonn is incomplete or illegible. Internal Revenue Service Tip. Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can also call 1-800-829-1040 to order a transcript. If you need a copy of your return, use Form 4606, Request for Copy of Tax Return. There is a fee to get a copy of your return. 1a Name shown on tax return. If a joint retum, enter the name shown first. 1b First social security number on tax return or employer identification number (see instructions) 2a If a joint return, enter spouse's name shown on tax return. 2b Second social security number if joint tax return 3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code 4 Previous address shown on the last return filed if different from line 3 5 If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party's pame, address, and telephone number. The IRS has no control over what the third party does with the tax information. Caution. If the transcript is being mailed to a third party, ensure that you have filled in line 6 and line 9 before signing. Sign and date the form once you have filled in these lines. Completing these steps helps to protect your privacy. 6 Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form number per request. ~ a Return Transcript, whic...,h,.....,.in-c-;lu-d...,.e~s~m-o-s..,.t-o-;f-:t';"he...... li,.. n-e..,i.,..te-ms of a tax return as filed with the IRS. A tax return transcript does not reflect changes made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series, Form 1065, Form 1120, Form 1120A, Form 1120H, Form 1120L, and Form 112OS. Return transcripts are available for the current year and returns processed during the prior 3 processing years. Most requests will be processed within 10 business days 0 b Account Transcript, which contains information on the financial status of the account, such as payments made on the account, penalty assessments, and adjustments made by you or the IRS after the retum was filed. Return information is limited to items such as tax liability and estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 30 calendar days. 0 c Record of Account, which is a combination of line item information and later adjustments to the account. Available for current year and 3 prior tax years. Most requests will be processed within 30 calendar days . D 7 Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available after June 15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days. 0 8 Fonn W-2, Form 1099 series, Fonn 1098 series, or Fonn 5498 series transcript. The IRS can provide a transcript that includes data from these information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this transcript information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. For example, W-2 information for 2007, filed in 2008, will not be available from the IRS until 2009. If you need W-2 information for retirement purposes, you should contact the Social Security Administration at 1-800-772-1213. Most requests will be processed within 45 days . D Caution. If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed with your retum, you must use Form 4506 and request a copy ofyour retum, which incfudes af( attachments. 9 Year or period requested. Enter the ending date of the year or period, using the mrn/ddlyyyy format. If you are requesting more than four years or periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter each quarter or tax period separately. Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax information requested. If the request applies to a jOint return, either husband or wife must sign. If signed by a corporate officer, partner, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute Form 4506-T on behalf of the taxpayer. Note. For transcripts being sent to a third party, this form must be received within 120 days of signature date. Telephone number of taxpayer on line 1a or 2a ~ Signature (see instructions) Date Sign Here ~ Title (if line 1a above is a corporation, partnership, estate, or trust) ~ Spouse's signature Date For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 37667N Fcrm 4506-T (Rev. 1-2010) paQe 11 of12 Form 4S06-T (Rev. 1-2010) Page 2 Chart for all other transcripts Partnerships. Generally, Form 4506-T General Instructions can be Signed by any person who was a Purpose of fonn. Use Form 4506-T to If you lived in Mail or fax to the member of the partnership during any part request tax retum information. You can or your business "Intemal Revenue of the tax period requested on line 9. also designate a third party to receive the was in: Service" at: All others. See Internal Revenue Code information. See line 5. section 61 03(e) if the taxpayer has died, is Tip. Use Form 4506, Request tor Copy of Alabama, Alaska, insolvent, is a dissolved corporation, or if a Tax Retum, to request copies of tax Arizona, Arkansas, RAIVSTeam trustee, guardian, executor, receiver, or retums. California, Colorado, P.O. Box 9941 administrator is acting for the taxpayer. Where to file. Mail or fax Form 4506-T to Florida, Hawaii, Idaho, Mail Stop 6734 Documentation. For entities other than Iowa, Kansas, the address below for the state you lived in, Ogden, UT 84409 individuals, you must attach the Louisiana, Minnesota, or the state your business was in. when authorization document. For example. this Mississippi, that retum was filed. There are two address could be the letter from the principal officer Missouri, Montana, u.t:. charts: one for individual transcripts (Form :: ... c~ authorizing an employee of the corporation Nebraska, Nevada, .0 , '"' 0 ... 1040 series and Form W-2) and one for all :l ~ or the Letters Testamentary authorizing an New Mexico, a.c ~ ~.!! other transcripts. North Dakota, 2}, E u individual to act for an estate. paQe 12 of 12 PREMIUM CREDIT BUREAU 9594 NW 41 STREET SUITE 106 DORAL, FL 33178 305-468-1560 GEMINI CAPITAL INC. 250 NW 23 RD ST. UNIT 205 MIAMI, FL 33127 BORROWER SIGNATURE AUTHORIZATION FORM I/We hereby authorize GEMINI CAPITAL INC. to verify my past and present employment earnings records, bank accounts, stockholdings, and any other asset balances that are needed to process application. I/We further authorize GEMINI CAPITAL INC. to order a consumer credit report and verify other credit information, including past and present mortgages, landlord references, and release or disclose personal health information. GEMINI CAPITAL INC. may also utilize the services of PREMIUM CREDIT BUREAU to further verify my personal credit information and the information GEMINI CAPITAL INC. obtains is only to be used in the processing of my application. It is understood that a copy of this form will also serve as authorization. This authorization expires 120 days from the date indicated below. Privacy Act Notice: This information is to be used by the agency collecting it or its assignees in determining whether you qualify as a prospective under its program. It will not be disclosed outside the agency except as required and permitted by law. The information requested in this form is authorized by Title 38, USC, Chapter 37 (if VA); by 12 USC, Section 1701 et. seq. (if HUO/FHA); by 42 USC, Section 1452b (if HUD/CPD); and Title 42 USC, 1471 et. seq., or 7 USC, 1921 et. seq. (if USDA/FmHA). Borrower Signature Social Security No. Date Submitted into the public record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson City CJerk By signing this form you are agreeing to a charge by Ms Credit Ed (Get Credit Healthy) and Gemini Capital to pay $25.00 (twenty five dollars) for expense of simulation, analysis and report of clients credit information. DESIGNA TED CREDIT CARD AUTHORIZATION (PLEASE PRINT) Credit Card # . ______CVV Code: Expiration Date ___1__- Yisa MC j\1\.1EX Discover Name as it appears on the card to be billed:______ Signature: ______~Date: ______ Billing Address :______ Submitted into the public record in connection with items 05.2 on 06-09-11 Priscilla A. Thompson City Clerk