HomeMy WebLinkAboutSubmittal-Miami Bayside FoundationMIAMI BAYSIDE FOUNDATION
Advancing Miami's economy through the support of minority businesses
Kathleen Murphy
Executive Director
25 SE 2nd Ave., Ste 240
Miami, FL 33131
T: 305-379-7070 x204
M: 305-710-5433
Kathleena MismiBaysideFoandation.org
www.miamibaysidefoundation.org
MIAMI BAYSIDE FOUNDATION
A 'Marv-vul • tunotrnc ticvelupn cnl ur thr-• City of I•lianu lh+uugh lhp supputl of niln'ily bu,uti •,'..i'S
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
MIAMI liAYSI DIF FOUNDATION
Advancing Miami's economy through the support of minority 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 (FIU) with
funds toward an endowment and scholarship program in the amount of more 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 FIU. ler
Nearly 50 percent of all undergraduate students at FIU receive financial aid, and nearly
60 percent of those 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 FIU's student body.
"It was vital for the Miami Bayside Foundation's decision to add FIU, Miami's premier
public research university, to its list of partnering educational institutions," said Nathan Kurland,
chairman of the Bayside Foundation's scholarship committee. "There's such a need for financial
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.
SUbMl...iTED INTO THE
PUBLIC RECORD FOR
ITEMt5.ON 4/u
"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 of an
additional endowment fund created by the Foundation serving Miami Dade College. The fund at
Miami Dade College currently totals close to $1 million.
FIU 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 of the 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 of Miami.
For more information on the Miami Bayside Foundation, call (305) 379-7070, e-mail
info@miamibaysidetoundation.org or visit www.miamibaysidefoundation.org.
About Florida International University Foundation, Inc.
Florida International University Foundation, Inc. (FIU 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(c)(3) 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 play a
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 D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
Miami Dade
College
Student Name:
MIAMI DADE COLLEGE 1\11Ai\1I (BAYSIDE FOUNDATION
MIAMI BAYSIDE FOUNDATION
SCHOLARSHIP APPLICATION
2011-2012
Mailing Address:
Home Phone #: (
MD ID#: Campus:
Date of Birth:
Sex:
Ethnicity: (please circle) W B H A I 0
Work Phone #: ( )
E-Mail Address:
Marital Status:
High School Attended:
Citizenship: U.S. Citizen Perm. Resident: Visa:
Legal Residence: County: State:
Cumulative GPA:
Program GPA:
Other:
Expected Graduation Date: Degree Program: (please circle) 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
MAIL this completed form to:
Due Date: June 30th, 2011
Date
Yadira Codina
Miami Dade College
District Financial Aid Office —
11011 S. W. 104th Street
Miami, FL 33176
Room 1127
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
MIAMI BAYSIDE FOUNDATION
Ad.�
u%71
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, leadership, 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.
All mailed applications must be postmarked no later than June 30th, 2011.
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
CITY OF MIAMI
_COMMISSION DISTRICTS AND ZIP CODES
Honorable Mayor Tomas P. Regalado - Citywide
=Zip Codes
Commission District & Commissioner Name
Wfredo (Willy) Gorl
2. Marc Samoff
3. Frank Carollo
4, Francis Suarez
5. Richard P Dunn II
it.tr .Mti
'MST
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33125
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331.
3314
Created by the Crty of Kam. Planntrg Department
Cate C IC
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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
rim
/1:37/111‘
_- I
Miami Bayside Foundation Announces Minority
Scholarship Recipients
• ® h.9cae DATE: April 21,
2011
MEDIA CONTACT:
Kiskinis Communications. Inc.
Melissa Nobles 305-4=7-1224
Miami llarsjde Foundation Announces Minority Scholarship Recipients
Foundation Selects Nine Miami Dade College Students
The Miami Bayside Foundation announced the recipients of its scholarship program on Thursday. April 21
at a reception on the front steps of Miami Dade College's Wolfson Campus — Building I (300 Northeast
Second Avenue. Miami. FL 33132). Each enrolled in the Miami Dade College School of Business. a total
of nine students were selected for the spring 2011 semester scholarship program
"The Miami Bayside Foundation is proud to foster young entrepreneurs." said Nathan Kurland. chairman
of the Foundation's scholarship committee. "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: Jeffrey Green. Mckenzv Valentin. Paulette Petit-
Frere.Jackson David. Mabel Cruz. Jennifer Nacipucha. Ralph Davis, Juliette Mathurin and Lucyla
Escoto.
Partnering with Miami Dade College. the Miami Bayside Foundation created a vocational and educational
scholarship endowment fund for minority students. Since its creation, the Foundation has provided grants
to more than 80 students and currently has an endowment fund of close to $1 million.
"We are so pleased to have the Miami Bayside Foundation's support:" said Lula Rodriguez. vice
president, Advancement and External .affairs. "Their generous donation helps us ensure that we can
continue changing lives through the opportunity of an education."
The Miami Bayside Foundation a City of Mianti-based nonprofit established in 1988. created and
administers a loan program for minority businesses, established a scholarship fund for minorities studying
entrepreneurship and business. and has programs that provide technical assistance to minority businesses
in the City of Miami.
Miami Dade College is the nation's Largest institution of higher education with an enrollment of more than
170.000 students. It is also the nation's top producer of associate in arts and science degrees. The
colleges eight campuses and outreach centers offer more than 300 distinct degree programs including
several baccalaureate degrees in education. public safety. supervision and management and nursing. In
fact, its academic and workforoe training programs have served as national models of excellence. MDC is
also renowned for its rich cultural programming. It is home of the Miami Book Fair International Miami
International Film FestivaL the Cultura del Lobo performing arcs series. the National Historic Landmark
Miaini Freedom Tower. a sculpture park and a large art gallery and theater system. MDC has served
nearly 2.000.000 students since it opened its doors in 1960.
To see photos from the reception. visit the Foundation's photo caller%.
MIAMI RAYSIDE FOUNDATION
2011 Miami Bayside Foundation, all rights reserved
Miami Website Design. Edmund -cc Development & Web Design by Miami Web Design
0
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
mit
'uC
tM1AMI RAW Di FOUNDATION
305) 379-7070
25 SE 2nd Avenue. Suite 240
Miami_ FL 33131
intii.0 miamibaysidetoundation.ors
Horne About MBF Leadershi Loans Programs Scholarships Photo Gallery Recent News Contact Us
Program s
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 community
organizations engaged in economic development.
Announcing a partnership in 2011. the Miami Bayside Foundation teamed up with the
Miami -Dade chapter of SCORE. the premier resource for small business advice and
mentoring in America. This partnership allows candidates and future minority business
owners recommended by Miami Bayside Foundation access to all ofSCORE's services
tree of charge. This includes one-on-one mentoring as well tree registration to their
ongoing workshop programs offering the tools needed by small business owners.
SCORE Miami matches startup business owners with more than 65 working and retired
executives who donate their time and expertise as mentors. They offer confidential small
business counseling to help start and build your business — from planning. to startup. to
success.
The Miami Bayside Foundation allows for any qualified candidate to receive the
organization's resources free of charge. including:
• Group workshops offering specialized training on weeknights and Saturdays
• Online courses and podcasts on various topics available 24 hours a day . seven
days a week
• One-on-one business counseling with experts in a variety of fields
If you are interested in participating in the Miami Bayside Foundation partnership with
SCORE Miami. and receiving such services free of charge. please call (305) 379-7070
or e-mail info a niamibaysidefoundation.ortg.
To find out more about SCORE Miami. visit www.scoremiami.org.
To view a list of upcoming SCORE Miami workshops. click here for their calendar.
M IAM I RAYS I [)F. F()U N DATION
C) 2011 Miami Bayside Foundation all rights reserved
Miami Website Design_ Ecommerce Development & Web Design by Mann Web Design
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
MIAMI BAYSIDE FOUNDATION
Advancing economic development in the City of Miami through the support of minority businesses
25 SE 2" �i Avenue Suite 240, Miami, FL 33131
Board of Directors
Chair
Bob Powers
Reti red
565 NE 66 Street
Miami, FL 33138
305-299-0052
bob powers@bellsouth.net
Vice -Chair
Pamela Weller
Senior General Manager
Bayside Marketplace
Bayside Boulevard, Suite 106
Miami, FL 33132
305-577-3344 x7010
Pamela.welier@ggp.com
Treasurer
Josie Correa
Executive Director
Downtown Miami Partnership, Inc.
25 SE 2nd Avenue, Suite 240
Miami, FL 33131
305-632-1014
josielegido@gmail.com
Secretary
Maria Korge
Managing Partner
Korge & Co.
459 SW 19`h Road
Miami, FL 33129
305-858-2270
maria@korgeco.com
Trustees
Rolando Aedo
Executive Vice President/Chief Marketing Officer
Greater Miami Convention & Visitors Bureau
701 Brickell Avenue, Suite 2700
Miami, Florida USA 33131
305-539-3090
RolandoPgmcvb.com
Benny Carmona
Senior Vice President/Bank Lending Division
Total Bank
2720 Coral Way, 2nd floor
Miami, Florida 33145
(305) 476-6399
bcarmona@totalbank.com
Jeff Cazeau
Kleiner Cazeau
18305 Biscayne Blvd., Ste. 302
Aventura, Florida 33160
(305) 517-1392 ext 102
jcazeau@kleinercazeau.com
Luis Cuervo
Executive Director
CAMACOL Loan Fund Program
1401 West Flagler Street
Miami, FL 33135
305-642-3870
lcuervo@att.net
Bill Diggs
President & Chief Executive Officer
Miami Dade Chamber of Commerce
11380 NW 27th Avenue, Suite 1328
Miami FI 33167
305-751-8648
BDiggs@m-dcc.org
Nicole E. Ewan
Record Systems Coordinator
City of Miami
3500 Pan American Drive
Miami, FL 33133
786-973-7787
nikkiewan@yahoo.com
Nathan Kurland
Licensed Realtor
3121 Commodore Plaza
Coconut Grove, FL 33133
215-776-1038
Nrkpax@aol.com
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
Citv Clerk
MBF Board of Directors (page 2)
Beatrice Louissant
Chief Executive Officer
South FL Minority Supplier Development Council
9499 NE 22hd Avenue, Suite 201
Miami, FL 33138
305-762-6151
Beatrice@sfmsdc.org
Louis McMillian
Global Investment Realty
235 NE 26th Street
Miami, FL 33131
305-469-8400
Louis@globalinvestmentrealty.com
Pablo Perez -Cisneros
Retired
1420 Brickell Bay Drive
Miami, FL 33131
305-373-8104
pabioricisneros@bellsouth.net
Non -Board Committee Members
Adam Dunshee
Retired
500 NE 50th Terrace
Miami, FL 33137
(303) 725-8098
adam.dunshee@Rmail.com
Loan Committee
Kathleen O'Neil
Retired
3301 NE 5th Avenue
Apt 310
Miami, FL 33137
786-514-2111
KLOneil@me.com
Finance & Audit Committee
June 2011
Submitted into the public
record in connection with
items D5.2 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
v, 1. _ Copy of Warranty Deeds, Owner's Title Insurance Policy and Survey of all Real Estate
owned by business and/or guarantors and copy of Closing Statements evidencing
▪ va - original purchase.
n. 3 2. _ Evidence of tax assessment values and any existing appraisals not older than six (6)
D 3 months. The appraiser must be State Certified and have been licensed for at least two
A —I CD c (2) years.
.� o c c z 3. _ Evidence of existing mortgage balances and copy of corresponding documents. State
n . ' c License as appropriate.
• o 7 = 4. Written evidence of updated insurance coverage on property owned.
3 z- n
5. _ Minority Business Certification from one of the 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:
Contact Person:
Telephone:
Sole Proprietorship ( ) Partnership ( ) Corporation ( ) Other ( )
Ownership Distribution: (list stockholders, partners, and owner names)
Name: Title: #of yrs % SS#
Address:
Name: Title: #ofyrs %SS#
Address:
Name: Title: #of yrs % SS#
Address:
Type of Business: Date 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
Date
Original Loan
Amount
Present Balance
Repayment Terms
Status:
Business Debts and Credit Relationships - Include Mortgages Payable, Contracts. Notes, Business Debts, etc.
Agency's Name:
Original
Date
Original Loan
Amount
Present Balance
Repayment Terms
Security:
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
page 2 of 12
LOAN REQUEST
Specific Loan Purpose (Check all that apply)
( ) Working Capital $
( ) Purchase of Inventory $
( ) Purchase of Equipment $
( ) Expansion $
( ► Other $
Loan Amount $ 0
EXPLAIN
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 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:
Applicant Signature: Date:
Applicant Name and Title:
Submitted into the public
record in connection with
items DS.2 on 06-09-11
Priscilla A. Thompson
City Clerk
Page 2 of Business Loan Application
page 3 of 12
Personal Financial Statement
(This form is to be filled out by each Applicant)
Borrower
SECTION 1— PERSONAL INFORMATION
Spouse
Borrower's Name:
Spouse's Name
SS#:
Home Phone:
Date of Birth:
SS#:
Home Phone:
Date of Birth:
( ) Married ( ) Unmarried
( ) Separated
Place of Birth:
Place of Birth:
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 I ) rent # yrs.
Nearest relative not living with you.
Name:
Address:
Phone:
Relationship:
Borrower
SECTION 2— EMPLOYMENT INFORMATION
Spouse
Name and address of employer:
Years on this job:
Name and address of employer:
Years on this job:
Years employed in this
line of work:
Years employed in this
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 LIABILITIES
Monthly Income
Borrower
Co -Borrower
Total
Liabilities
Borrower
Co -Borrower
Total
Salary
$
$
$
As endorser or Co-
$
$
$
0
maker
0
Net Investment
$
$
$
Legal Claims and
$
$
$
Income
0
judgments
0
Real Estate Income
$
$
$
Provisions for Fed.
$
$
$
0
Income Tax
0
Other Income
$
$
$
Other Special Debt
$
$
$
Describe:
0
Describe
0
0
0
Total
c:S
OS
OS
Total
0$
05
&
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
Pit., (lark
-1-
page 4 of 12
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
Complete Section 12
$
Installment Accounts (Other)
Monthly Payments
$
$
Real Estate
Describe in Section 13
$
Loan of Life Insurance
$
Mortgage on Real Estate
Describe in Section 13
$
Automobile — Present value
$
Unpaid Taxes
Describe in Section 10
$
Other Personal Property
Describe in Section 9
$
Other Assets
Describe in Section 9
$
Other Liabilities
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
Holder
Original
Balance
Current
Balance
Payment
Amount
Frequency
(monthly, etc.)
How Secured
Type of Collateral
SECTION 8 - STOCKS AND BONDS
Number of
Shares
Name of Securities
Cost
Market Value
Quotation/Exchange
Date of
Quotation
Total Value
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
page 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
Type of Property
Address
Date purchased
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
Yes
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 of title
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, credit 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 1/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 penalties!, 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 D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
Page 3 of Personal Financial Statement
page 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 ( 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? i ) 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:
Applicant Signature:
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
page 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:
Name: Title:
Date: Signature:
Name: Title:
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
page 8 of 12
BUSINESS PLAN FOR COMPLIANCE
WITH JOB CREATION AND RETENTION
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
Business Name:
A. Full Time Employees at present:
C. Total Number of Jobs Created (A — B):
List of Current Employees (Use separate sheet if necessary)
B. Projected Full Time Employees within two years from loan approval:
Name:
Social Security
Number
Family Size
Annual
Salary
Position
Hrs per
week:
Projected Employees (Use separate sheet if necessary)
Name:
Social Security
Number
Family Size
Annual
Salary
Position
Hrs per
week:
Skill/Training required for new positions (use separate sheet if necessary)
Job Title:
Type of Test
Required
Education
Required
License(s)
Required
Yrs of Experience
Required
Other Requirements
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:
Applicant's Name:
Applicant's Signature:
Date:
Date:
page 9 of 12
INVENTORY OF FIXTURES AND EQUIPMENT OWNED
COMPANY NAME:
Description
Serial Number
Year
Purchased
Condition
(new, fair, needs
repair, etc.)
Estimated
Current Value
Date:
SIGNATURE:
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
page 10 of 12
Form 4506-T
(Rev. January 2010)
Department of the Treasury
Internal Revenue Service
Request for Transcript of Tax Return
► Request may be rejected if the form is incomplete or illegible.
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
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 4506, Request for Copy of Tax Return. There is a tee to get a copy of your return.
la Name shown on tax return. If a joint return, enter the name shown first.
lb 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 name, 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, which includes most of the line items 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 1120S. 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 ❑
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. .
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
7 Verification of Nonfiling, which is proof from the IRS that you did not file a retum 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 . .
8 Form W-2, Form 1099 series, Form 1098 series, or Form 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 . . .
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 return, you must use Form 4506 and request a copy of your retum, which includes all attachments.
9 Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy 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 1 am either the taxpayer whose name is shown on line la 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 la or 2a
Sign
Here
Signature (see instructions) Date
Title (if line 1 a 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 Form 4506-T (Rev. 1-2010)
page 11 of 12
Form 4506-T (Rev. 1-2010)
Page 2
General Instructions
Purpose of form. Use Form 4506-T to
request tax return information. You can
also designate a third party to receive the
information. See line 5.
Tip. Use Form 4506, Request for Copy of
Tax Retum, to request copies of tax
retums.
Where to file. Mail or fax Form 4506-T to
the address below for the state you lived in,
or the state your business was in, when
that retum was filed. There are two address
charts: one for individual transcripts (Form
1040 series and Form W-2) and one for all
other transcripts.
If you are requesting more than one
transcript or other product and the chart
below shows two different RAIVS teams,
send your request to the team based on
the address of your most recent return.
Automated transcript request. You can
call 1-800-829-1040 to order a transcript
through the automated self-help system.
Follow prompts for "questions about your
tax account" to order a tax return
transcript.
Chart for individual
transcripts (Form 1040 series
and Form W-2)
If you filed an
individual return
and lived in:
Mail or fax to the
"internal Revenue
Service" at:
Florida, Georgia,
North Carolina,
South Carolina
RAIVS Team
P.O. Box 47-421
Stop 91
Doraville, GA 30362
770-455-2335
Alabama, Kentucky,
Louisiana,
Mississippi,
Tennessee, Texas, a
foreign country, or
A.P.O. or F.P.O.
address
RAIVS Team
Stop 6716 AUSC
Austin, TX 73301
512-460-2272
Alaska, Arizona,
California, Colorado,
Hawaii, Idaho, Illinois,
Indiana, Iowa, Kansas,
Michigan, Minnesota,
Montana, Nebraska,
Nevada, New Mexico,
North Dakota,
Oklahoma, Oregon,
South Dakota, Utah,
Washington,
Wisconsin, Wyoming
RAIVS Team
Stop 37106
Fresno, CA 93888
559-456-5876
Arkansas,
Connecticut, Delaware,
District of Columbia,
Maine, Maryland,
Massachusetts,
Missouri, New
Hampshire, New
Jersey, New York,
Ohio, Pennsylvania,
Rhode Island, Vermont,
Virginia, West Virginia
RAIVS Team
Stop 6705 P-6
Kansas City, MO
64999
816-292-6102
Chart for all other transcripts
If you lived in
or your business
was in:
Mail or fax to the
"Internal Revenue
Service" at:
Alabama, Alaska,
Arizona, Arkansas,
California, Colorado,
Florida, Hawaii, Idaho,
Iowa, Kansas,
Louisiana, Minnesota,
Mississippi,
Missouri, Montana,
Nebraska, Nevada,
New Mexico,
North Dakota,
Oklahoma, Oregon,
South Dakota,
Tennessee, Texas,
Utah, Washington,
Wyoming, a foreign
country, or A.P.O. or
F.P.O. address
RAIVS Team
P.O. Box 9941
Mail Stop 6734
Ogden, UT 84409
801-6
Connecticut,
Delaware, District of
Columbia, Georgia,
Illinois, Indiana,
Kentucky, Maine,
Maryland,
Massachusetts,
Michigan, New
Hampshire, New
Jersey, New York,
North Carolina,
Ohio, Pennsylvania,
Rhode Island, South
Carolina, Vermont,
Virginia, West Virginia,
Wisconsin
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RAIVS Team
P.O. Box 145500
Stop 2800 F
Cincinnati, OH 45250
859-669-3592
Line lb. Enter your employer identification
number (EIN) if your request relates to a
business return. Otherwise, enter the first
social security number (SSN) shown on the
retum. For example, if you are requesting
Form 1040 that includes Schedule C
(Form 1040), enter your SSN.
Line 6. Enter only one tax form number per
request.
Signature and date. Form 4506-T must be
signed and dated by the taxpayer listed on
line 1 a or 2a. If you completed line 5
requesting the information be sent to a
third party, the IRS must receive Form
4506-T within 120 days of the date signed
by the taxpayer or it will be rejected.
Individuals. Transcripts of jointly filed
tax returns may be furnished to either
spouse. Only one signature is required.
Sign Form 4506-T exactly as your name
appeared on the original retum. If you
changed your name, also sign your current
name.
Corporations. Generally, Form 4506-T
can be signed by: (1) an officer having legal
authority to bind the corporation, (2) any
person designated by the board of
directors or other governing body, or (3)
any officer or employee on written request
by any principal officer and attested to by
the secretary or other officer.
U
A
V
Partnerships. Generally, Form 4506-T
can be signed by any person who was a
member of the partnership during any part
of the tax period requested on line 9.
All others. See Internal Revenue Code
section 6103(e) if the taxpayer has died, is
insolvent, is a dissolved corporation, or if a
trustee, guardian, executor, receiver, or
administrator is acting for the taxpayer.
Documentation. For entities other than
individuals, you must attach the
authorization document. For example, this
could be the letter from the principal officer
authorizing an employee of the corporation
or the Letters Testamentary authorizing an
individual to act for an estate.
Privacy Act and Paperwork Reduction
Act Notice. We ask for the information on
this form to establish your right to gain
access to the requested tax information
under the Internal Revenue Code. We
need this information to properly identify
the tax information and respond to your
request. You are not required to request
any transcript; if you do request a
transcript, sections 6103 and 6109 and
their regulations require you to provide this
information, including your SSN or EIN. If
you do not provide this information, we
may not be able to process your request.
Providing false or fraudulent information
may subject you to penalties.
Routine uses of this information include
giving it to the Department of Justice for
civil and criminal litigation, and cities,
states, and the District of Columbia for use
in administering their tax laws. We may
also disclose this information to other
countries under a tax treaty, to federal and
state agencies to enforce federal nontax
criminal laws, or to federal law enforcement
and intelligence agencies to combat
terrorism.
You are not required to provide the
information requested on a form that is
subject to the Paperwork Reduction Act
unless the form displays a valid OMB
control number. Books or records relating
to a form or its instructions must be
retained as Tong as their contents may
become material in the administration of
any Internal Revenue law. Generally, tax
retums and return information are
confidential, as required by section 6103.
The time needed to complete and file
Form 4506-T will vary depending on
individual circumstances. The estimated
average time is: Leaming about the law
or the form, 10 min.; Preparing the form,
12 min.; and Copying, assembling, and
sending the form to the IRS, 20 min.
If you have comments conceming the
accuracy of these time estimates or
suggestions for making Form 4506-T
simpler, we would be happy to hear from
you. You can write to the Internal Revenue
Service, Tax Products Coordinating
Committee, SE:W:CAR:MP:T:T:SP, 1111
Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send the
form to this address. Instead, see Where to
file on this page.
page 12 of 12
PREMIUM CREDIT BUREAU
9594 NW 41 STREET SUITE 106
DORAL, FL 33178
305-468-1560
GEMINI CAPITAL INC.
250 NW 23R0 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 HUD/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 D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk
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.
DESIGNATED CREDIT CARD AUTHORIZATION (PLEASE PRINT)
Credit Card #. CVV Code:
Expiration Date /
Visa
_ MC AMEX Discover
Name as it appears on the card to be billed:
Signature: Date:
Billing Address :
Submitted into the public
record in connection with
items D5.2 on 06-09-11
Priscilla A. Thompson
City Clerk