"Child Care Centers Child Care Financing Program Application" - Virginia

Child Care Centers Child Care Financing Program Application is a legal document that was released by the Virginia Department of Small Business and Supplier Diversity - a government authority operating within Virginia.

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  • Released on March 8, 2019;
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Child Care Centers
Child Care Financing Program Application
Please Review Program Guidelines & Application Help on Page 3
Applicant: __________________________________________________________ EIN: ____________________________________
Address: ____________________________________________________________ Phone: __________________________________
Address: ____________________________________________________________ Alternate/Cell Phone: ______________________
City: _________________________________________ State: _______ Zip: ___________ County: _________________________
Contact Name: __________________________________________ Email: ______________________________________________
Business Website: _____________________________________________________ Fax: ____________________________________
Entity Type: __________________________________ NAICS: _____________ Date Business Established: _____/_____/______
License Type: ☐ VDSS Licensed ☐ Regulated Religious-Exempt ☐ VDSS Certified Preschool
Annual Revenue: ____________________ Tell us about your business: ________________________________________________
______________________________________________________________________________________________________________
Business
Owners:
Name
SSN
Address
Office Held/Title
% of
Ownership
Loan Amount Requested: $_____________________ Loan Purpose: ___________________________________________________
Collateral:
___________________________________________________________________________________________________
Guarantor Name: ______________________________________
Guarantor Name: ______________________________________
Address: _____________________________________________
Address: ______________________________________________
City: __________________________ State: _____ Zip: ______ City: _________________________ State: _____ Zip: _______
SSN/EIN: _____________________________________________
SSN/EIN: _____________________________________________
Email: ________________________________________________ Email: ________________________________________________
Phone: ________________________________________________ Phone: ________________________________________________
Detailed Summary of Existing Business Debts:
Creditor
Original
Current
Loan
Maturity
Payment
Payment
Current:
Collateral
Amount
Balance
Date
Date
M, Q, A
Amount
Y or N
3/8/2019
1
Child Care Centers
Child Care Financing Program Application
Please Review Program Guidelines & Application Help on Page 3
Applicant: __________________________________________________________ EIN: ____________________________________
Address: ____________________________________________________________ Phone: __________________________________
Address: ____________________________________________________________ Alternate/Cell Phone: ______________________
City: _________________________________________ State: _______ Zip: ___________ County: _________________________
Contact Name: __________________________________________ Email: ______________________________________________
Business Website: _____________________________________________________ Fax: ____________________________________
Entity Type: __________________________________ NAICS: _____________ Date Business Established: _____/_____/______
License Type: ☐ VDSS Licensed ☐ Regulated Religious-Exempt ☐ VDSS Certified Preschool
Annual Revenue: ____________________ Tell us about your business: ________________________________________________
______________________________________________________________________________________________________________
Business
Owners:
Name
SSN
Address
Office Held/Title
% of
Ownership
Loan Amount Requested: $_____________________ Loan Purpose: ___________________________________________________
Collateral:
___________________________________________________________________________________________________
Guarantor Name: ______________________________________
Guarantor Name: ______________________________________
Address: _____________________________________________
Address: ______________________________________________
City: __________________________ State: _____ Zip: ______ City: _________________________ State: _____ Zip: _______
SSN/EIN: _____________________________________________
SSN/EIN: _____________________________________________
Email: ________________________________________________ Email: ________________________________________________
Phone: ________________________________________________ Phone: ________________________________________________
Detailed Summary of Existing Business Debts:
Creditor
Original
Current
Loan
Maturity
Payment
Payment
Current:
Collateral
Amount
Balance
Date
Date
M, Q, A
Amount
Y or N
3/8/2019
1
Child Care Centers
Child Care Financing Program Application
Certification as a Small Business:
☐ No
1. Does the business have 250 or less employees: ☐ Yes
☐ No
2. Does the business have less than $10,000,000 in annual gross revenues over each of the last three fiscal years: ☐ Yes
3. Does the business have less than $2,000,000 in net worth: ☐ Yes
☐ No
4. Is the business currently operating in Virginia: ☐ Yes
☐ No
Background Data: Answer the following questions and provide comments on questions answered “yes”
1. Have any owners, officers, directors, guarantors, general partners, stockholders or limited partners owning 20% or more of the business ever been
convicted of any criminal offense, other than minor motor vehicle violations? ☐ Yes
☐ No
2. Has the business or any owners, officers, directors, guarantors, general partners, stockholders of limited partners owning 20% or more of the
business file or been adjudicated as bankrupt? ☐ Yes
☐ No
3. Is the business or any owners, officers, directors, guarantors, general partners, stockholders or limited partners owning 20% or more of the business
involved in any pending lawsuits? ☐ Yes
☐ No
4. Does the business or any guarantors owe past due federal, state, or local taxes of any nature? ☐ Yes
☐ No
5. Is the Applicant, if a sole proprietorship, and all guarantors U.S. citizens or legal permanent residents? ☐ Yes
☐ No
Comments: ________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
☐ Yes ☐ No
☐ SBSD Website
Are you a current or past VSBFA Customer?
How did you hear about the VSBFA or this Loan Program?
☐ Bank Referral ☐ Economic Development Staff ☐ VSBFA Marketing Event ☐ Other _____________________________________________
Current Employment and Projected Job Creation and/or Retention:
# Full-Time Existing Jobs Located in Virginia ____________ #Full-Time Existing Jobs Located Outside of Virginia_______________
# Full-Time Existing Jobs Saved as a result of this Financing _______# Full-Time Equivalent Jobs Created as a result of this Financing __________
Average Hourly Wage Rate: $ ____________________ Provide a brief summary of how loan proceeds will save or create new jobs: ____________
__________________________________________________________________________________________________
Projected Child Care Positions:
# Existing Child Care Spaces ____________
# Existing Spaces Saved as the result of this Financing ________ # Spaces Created as a result of this Financing _________
Provide a brief explanation of how loan proceeds will create jobs and child care spaces:
_______________________________________________
__________________________________________________________________________________________________________________________
☐ I do not wish to provide this information
Government Monitoring Data:
☐ Female ☐ Male
☐ Hispanic or Latino ☐ Not Hispanic or Latino
Sex:
Ethnicity:
Business: ☐ Yes ☐ No
Business: ☐ Yes
☐ No
☐ Yes
☐ No
Woman-Owned
Minority-Owned
Veteran-Owned Business:
☐ American Indian or Alaska Native
☐ Asian
☐ White
☐ Black or African American
☐ Native Hawaiian or Other Pacific Islander
Race:
Authorization and Certification:
Applicants and Guarantors authorize the VSBFA to investigate all credit history, obtain credit reports, bank references, and any other information required
to process this application and as it deems necessary. The undersigned hereby certifies that all information provided in support of this application is true
to his/her best knowledge, and is submitted for the purpose of obtaining financial assistance from the VSBFA.
Because the VSBFA is a political subdivision of the Commonwealth of Virginia all information submitted with this application may be subject to a Freedom
of Information Act request.
Applicant: _______________________________________________________ Date: ____________________________________
By: ________________________________________________________ Title: _________________________________________
Guarantor: __________________________________________________ Date: _________________________________________
Guarantor: __________________________________________________ Date: ______________________________________
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Child Care Centers
Child Care Financing Program Application
Program Guidelines
The Virginia Small Business Financing Authority's (VSBFA) Child Care Financing Program (CCFP) is designed to assist Virginia child care providers in obtaining
financing for fixed asset needs and educational materials. VSBFA offers direct low-interest rate loans to regulated child care providers for quality enhancement projects or to
meet or maintain childcare standards. Funding is provided by the U.S. Administration for Children and Families through the Virginia Department of Social Services.
Eligible Borrowers:
Qualified borrowers are Virginia Department of Social Services (VDSS) licensed child care centers; unlicensed but regulated religious-exempt child care; or VDSS certified
preschools. To be eligible to apply for assistance under the Child Care Financing Program, the applicant must: a) be in “good standing” with the Division of Licensing
Programs of the Department of Social Services, b) demonstrate a reasonable assurance of repayment, and c) maintain business operations in Virginia.
Eligible Loan Purposes:
Fixed asset purchases and quality improvements directly related to the health, safety and welfare of the children, as well as the overall learning program, such as playground
equipment, tricycles, resilient surfacing for playground areas, lockable cabinet for poisonous substances, cribs, cots, blankets, cubbies, books, curriculum, and equipment
or infant care, etc. Minor building maintenance, renovations, or repairs necessary to comply with health and safety standards required by the VDSS, or to meet
necessary requirements for children with special needs, etc. The purchase of eligible transportation vehicles for use exclusively by childcare centers.
Ineligible Loan Purposes:
Loan funds may not be used for: refinance or loan consolidations expended to consolidate or repay any existing debts, for the purchase or improvement of land, or for
the purchase, construction, or permanent improvement of any building or facility, except repairs necessary to maintain the health and safety of the children and child care
providers during work hours. Loan funds may not be used to provide working capital.
Program Loan Amounts and Terms: The maximum loan amount for Child Care Centers is $150,000 and the maximum term is 7 years.
Personal Guarantees:
The program requires all individuals and business entities owning 20% or more of the applicant business (including a spouse owning 5% or more when the combined ownership
of both spouses is 20% or more) to provide a personal guaranty of the loan.
Program Fees: Non-refundable application fee of $100.
Application Help
Below are descriptions to help you complete the Child Care Financing Program Application. If you have additional questions or need information, please contact the VSBFA
at 804-371-8254 or email us at VSBFA@sbsd.virginia,gov. Additional information about this program and the other services offered by the Department of Small Business
and Supplier Diversity can be found at
www.sbsd.virginia.gov.
Business Legal Type: Provide the legal business structure of the business as registered with the State Corporation Commission (SCC). Examples are sole proprietorship,
partnerships, LLC, LLP, C Corp, S Corp, Non Profit Corp. etc.
Annual Revenue: Supply the last full year’s revenue figure.
NAICS: The applicant’s North American Industry Classification System code can be determined at
https://www.census.gov/cgi-bin/sssd/naics/naicsrch.
Business Owners: List all owners, officers, directors, and general partners of business and stockholders or limited partners owning 20% or more of business. Include any
spouses owning 5% or more when the combined ownership of both spouses is 20% or more.
Loan Purpose and Collateral: Describe specifically how the loan funds will be used. The uses must meet program guidelines above. Collateral can be a lien on business
or personal assets.
Projected Job Creation: If loan will create or save full-time jobs enter data based on your best evaluation. This is not a requirement of the program.
Projected Child Care Space Creation: If loan will create spaces enter data based on your best evaluation. This is not a requirement of the program.
Government Monitoring Data: This data is used to determine the usage of VSBFA programs within the small business community. You are not required to provide this
information, but are encouraged to do so. VSBFA does not discriminate on the basis of this information and this information will have no bearing on VSBFA’s credit decision
for this application. If you do not wish to provide the information a selection is provided.
Woman-Owned, Minority-Owned, or Veteran-Owned Business: Select yes if at least 51% of business is owned by one or more applicable categories.
Where and How to Submit an Application:
Email:
VSBFA@sbsd.virginia.gov
Express Mail/Hand delivery: 101 North 14th Street, 11th Floor Richmond, VA 23219
Mail:
P.O. Box 446, Richmond, VA 23218-0446
Fax: 804-225-3384
Application Process: What to Expect from the VSBFA
Completed applications will be reviewed and the Applicant will be contacted if additional information is required. Applicants will be notified of VSBFA’s credit decision and
if approved, the Applicant will be informed of the next steps in the process. Loan proceeds are used to make payments directly to vendor(s) or to reimburse borrowers for
costs, supported by paid receipts, incurred after the date of written loan approval from the VSBFA.
What to provide with the Application:
• Completed and signed copy of this Child Care Financing Application;
• Statement of Good Standing from the Division of Licensing Programs of the Department of Social Services; Certificate of Good Standing, Certificate of Fact, or
equivalent from the SCC;
• Copy of Current State License issued by the Department of Social Services, including licensing capacity for current enrollment and breakdown and fees by age group;
• Completed Child Care Regulatory Status Form;
• Copy of valid driver’s license for each guarantor and/or sole proprietor;
• Most recent 2 years business tax returns or business financial statements of the Applicant;
• Most recent 2 years personal tax returns; current personal financial statements on all guarantors;
• Non-Refundable application fee of $100; check or money order made payable to VSBFA for application fee.
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