Certification Phone Agenda for Multiple Certifications
Business Name:
Do you want to serve the local, regional, national or international market?
Please identify the individuals responsible for the following duties:
Financial decisions
Signing major documents
Personnel management
Marketing/sales
Payroll
Estimating
Purchasing of major items
Supervision of field operations
What jobs firm will undertake
Hiring/firing authority of management personnel
Signing authority for checks
Signing and co-signing for loans and/or lines of credit
Access to firm bank accounts
For all owners, directors, officers or management members that has an ownership or management interest in any other business, please provide the following information:
Name and address of other business:
Ownership percentage in other business:
Management role in other business:
List the 3 largest contracts completed in the past 3 years:
Contract 1
Name of Owner/Contractor:
Name/Location of Project:
Type of Work Performed:
Dollar Value of Contract:
Contract 2
Name of Owner/Contractor:
Name/Location of Project:
Type of Work Performed:
Dollar Value of Contract:
Contract 3
Name of Owner/Contractor:
Name/Location of Project:
Type of Work Performed:
Dollar Value of Contract:
List the 3 largest active jobs the company is currently working on:
Contract 1
Name of Owner/Contractor:
Name/Location of Project:
Type of Work Performed:
Project Start Date:
Anticipated Completion Date:
Dollar Value of Contract:
Contract 2
Name of Owner/Contractor:
Name/Location of Project:
Type of Work Performed:
Project Start Date:
Anticipated Completion Date:
Dollar Value of Contract:
Contract 3
Name of Owner/Contractor:
Name/Location of Project:
Type of Work Performed:
Project Start Date:
Anticipated Completion Date:
Dollar Value of Contract:
Please answer the following questions for all business owners (if more than two please add additional owners).
1st Owner’s Information
First and Last Name:
Actual money contributed toward the acquisition of the business (dollar amount):
Type and dollar value of equipment contributed to the business:
Type and dollar value of real estate contributed to the business:
Year of expertise in the industry:
SSN:
If applying for 8(a):
Spouse’s Name
Spouse’s SSN
2nd Owner’s Information
First and Last Name:
Actual money contributed toward the acquisition of the business (dollar amount):
Type and dollar value of equipment contributed to the business:
Type and dollar value of real estate contributed to the business:
Year of expertise in the industry:
SSN:
If applying for 8(a):
Spouse’s Name
Spouse’s SSN
Please be ready to provide a detailed explanation, including supporting documentation, for any “Yes” answers below.
Are any owners currently under indictment, on parole or probation?
Has any owner ever been charged with and or arrested for any criminal offense other than a minor motor vehicle violation? Include offenses which have been dismissed, discharged, or not prosecuted.
Has any owner even been convicted, placed on pretrial diversion, or placed on any form of probation, including adjudication withheld pending probation, for any criminal offense other than a minor vehicle violation?
Does your business currently hold any other certifications?
Has your business ever applied for these certifications before?
Has the business (under any of its names) or any of its owners, Board of Directors, officers or management personnel, ever withdrawn an application for the DBE, 8(a) or SDB program, or ever been denied certification, decertified, or debarred or suspender or otherwise had bidding privileges denied or restricted by any state or local agency, or Federal entity? If yes, please provide the following:
State
Name of agency
Detailed explanation
Does your business share any resources with any other business or individual (office facilities, storage space, equipment, personnel, inventory, financing)? Remember, home-based businesses share resources with individual!
Do you have union agreements?
Are your employees covered by a union agreement?
Union Name:
Local:
Affiliation:
Is the business bonded? If so, what is the bonding amount? What is the name and address of the bonding/security business?
Is your business a distributor? If so, what’s the Average Dollar Value of your Inventory?
Is your business a manufacturer? If so, list basic equipment and indicate whether equipment is leased or owned, and provide approximate dollar value.
Is your business a contractor? If so, please provide the following information:
Contractor License Number
License Type
Trade Specialty
Union Name/Local and Affiliation, if applicable
Most recent project name
State Date
Finish Date
Geographical area
Dollar Value
Name of responsible managing officer or employee
Is your business a transport company? If so, please provide the following information:
Are you an independent carrier?
Do you have common carrier operating authority at the intrastate or interstate level?
What is the name of your insurance carrier?
At any time has your business had any subsidiaries or affiliates or been a subsidiary of another business? If so, please provide the following information:
Name, address and telephone number of the subsidiary, affiliate or parent company.
Describe the relationship of your business to the subsidiary, affiliate or parent company.
Does your business have any administrative, management, or operating agreements with any other companies? For example, do you have a company attorney, CPA, management company, payroll company, leasing company, etc? If yes, please include a copy of this agreement with your application.
Is the business involved in any pending lawsuits? If so, please provide details with your application (copy of the complaint, etc.)
Is the business involved in bankruptcy or insolvency proceedings? If so, please provide details with your application (bankruptcy filing documents, etc.)
SBA 8(a) Specific Questions
Is the business concern delinquent in filing any applicable business tax returns?
Does the business concern have any past due taxes or any other delinquent Federal, state or local financial obligations outstanding or liens filed against it? If yes, provide the tax year, what specifically is delinquent, the taxing authority, whether or not a repayment plan is in place, evidence of repayment arrangements, and proof of compliance with repayment arrangements.
Does the business concern have any existing management, joint venture, indemnity, consulting, distributorship, licensing, trust, or franchise agreements? If yes, include copies of these agreements.
Have there been any changes in ownership of the business concern in the past two years? If yes, identify prior owners by name, percentage of ownership, and dates of ownership.
Does the business concern have an ownership interest in, or an affiliation with, any other business concern? If yes, for each affiliate and/or subsidiary provide the seven categories of information listed in question
Does any other business concern or other organization have an ownership interest in the business concern? If yes, provide for each business concern or organization the following information:
The name and address
The type of business or organization
The names of every owner, director, and officer
If the owner is a business concern, the Primary NAICS code
The nature of the entity’s relationship with the applicant business concern
The percentage of ownership of the applicant business concern
A statement as to whether the other business concern is a current or former 8(a) BD program participant.
Does the business concern buy from, sell to, or use the services or facilities of any other business concern, or otherwise conduct business with any other business concern, in which a principal of the applicant business concern has a financial or any other interest? If yes, provide the name of the other business concern, the name of that concern’s president or CEO, the name(s) of the principal(s) of that concern, and type of interest.
Has the business concern previously applied and been approved for the 8(a) BD Program? If yes, provide the dates of participation in the 8(a) BD program, reason for ending participation (e.g., graduation, termination), and SBA servicing office of record.
Does (or do) any outside entity(ies) or individual(s) provide financial or bonding support, licenses or required professional certification, office space or equipment to the applicant business concern? If yes, provide the name of the entity(ies) or individual(s), the nature of assistance (in the case of licenses and professional certifications, include the type of license and/or certification) and copies of any existing agreements governing that relationship.
Does anyone other than an economically and socially disadvantaged individual (see discussion in Individual Information Form 1010-IND) hold the highest position in the business concern (President/CEO, Managing Member, Managing Partner, Sole Proprietor)?
Does any employee, owner, director, officer, partner or management member who is not economically and socially disadvantaged receive compensation or dividends from the applicant business concern that exceeds the compensation of the highest ranking individual of the business concern?
Did a third party (person or entity) not employed by the applicant business concern complete or help the business concern complete this form (e.g., attorney, accountant, appraiser, agent, or other representative)? If yes, complete SBA Form 1010-REP and submit it with your application materials.
Is the applicant business concern a party to any pending civil lawsuit? If yes, summarize its interest in the suit, a summary of the claims, the current status, and provide a copy of the complaint filed in the suit.
Has the business concern previously received an SBA loan, or has the business concern ever been an owner, stockholder or guarantor for another business concern which has received an SBA loan? If yes, provide the loan recipient’s name, date approved, and current status of the loan.
Has the business concern filed for bankruptcy or insolvency in the past 7 years? If yes, provide details and a copy of the bankruptcy court’s final order.
Does the business concern own any assets of a previously certified 8(a) BD Program participant? If yes, provide the business name of the previous 8(a) BD Program participant, name and title of individual(s) claiming disadvantage for previous participant, address of previous participant business concern, dates of participation, and SBA servicing office of record.
Does the business concern have a negative net worth or working capital position?
Does the individual holding the business concern’s highest position devote less than fulltime to the operation of the applicant business concern?
Has the business concern earned revenues in its primary NAICS code for less than the immediate past two years?
Has the business concern been in business for less than two years? If yes, you will need to seek SBA’s approval for a waiver of the rule that the business concern must be in business for two years prior to application by submitting information to demonstrate the business concern’s potential for success.
8(a) Addendum
Statement of disadvantage:
Please provide specific information pertaining to incidents of discrimination(names, dates and places) that have resulted in a negative impact in regards to your entry/advancement in the business world (promotions, wage increases, contract awards, etc.).