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Home My WebLink AboutSubmittal-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 rrr. 33125 Ri'vlAhl0 A 331. 3314 Created by the Crty of Kam. Planntrg Department Cate C IC C recut -it', OMMISSIG11 DISTRICTS CU n, I $ty.viCle 55 I I 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 -c 0 at c c 0 u c '1 0 u 0 l0 O c 0 W 0tri E w c 0 0. E 0 -c H m a 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