(l) a b
usiness, franchise or location of which the undersigned has already applied for and received
a grant under the Program.
___ 8. The Applicant understands that it is ineligible to receive a grant under the Program if any owner of
greater than 10% of the equity interest in the Applicant: (i) has within the prior three-years been convicted
of or had a civil judgment rendered against such owner, or has had commenced any form of parole or
probation (including probation before judgment), for (A) commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (federal, state or local)
transaction or contract under a public transaction, (B) violation of federal or state anti-trust or
procurement statutes, or (C) commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property; or (ii) is presently indicted
for or otherwise criminally or civilly charged by a government entity, (federal, state or local) with
commission of any of the offenses enumerated in subparagraph (i) above.
___ 9.
The Applicant has not and will not apply for or receive any other grant through or under the
Program. Further, no majority owner of the Applicant has applied for or received, nor will any majority
owner of the Applicant apply for or receive, any other grant through or under the Program on behalf of
any other business for which such person is also a majority owner. The undersigned hereby represents
and warrants, as the owner of the Applicant, that the Applicant is the undersigned’s eligible business with
the highest gross revenue. The Applicant agrees that if a second award is issued, then one or both awards
will be voidable at the discretion of the State, CalOSBA, GO-Biz and/or Lendistry, as applicable.
___ 10. The Applicant acknowledges and agrees that, if the Applicant is representing itself as being
women-owned, veteran-owned or owned by one or more of the following racial or ethnic groups (as
indicated on the Applicant’s application) (i) African American/Black, (ii) Asian, (iii) Native American or
Alaska Native, (iv) Native Hawaiian or Pacific Islander, or (v) LatinX/Hispanic for the purposes of
establishing status as underserved for a grant under the Program, then, in each case, at least 51% of the
Applicant’s business must be owned by such persons and at least 51% of the Applicant’s business must be
run on a daily basis by such persons to satisfy such priority requirement. The Applicant, in reliance on the
foregoing grant priority, certifies that it meets the foregoing priority requirements. (Please initial if the
Applicant is either relying on the foregoing priority requirement or if the foregoing priority requirement
is inapplicable to the Applicant.)
___ 11. The undersigned, on behalf of the Applicant, hereby authorizes the State of California and its
designated authorized representatives, including without limitation CalOSBA, GO-Biz and Lendistry, to
request access to, and to review, the Applicant, the Applicant’s tax return information and other
information related to the Applicant and its owners that may be requested by such representatives, which
may include an investigatory background check of the Applicant or its owners. The Applicant
acknowledges that Lendistry will confirm the Applicant’s eligibility for the Program and the eligible grant
amount thereunder based, in part, on the tax and other documents provided by the Applicant, and the
State of California, CalOSBA and GO-Biz may rely on such confirmation and tax and other documents in
making a grant to the Applicant. The Applicant further affirms that the tax return information provided in
connection with the Program is identical to the tax return information submitted to the Internal Revenue
Service. The Applicant understands, acknowledges and agrees that the State of California and its
authorized representatives, including without limitation CalOSBA, GO-Biz and Lendistry, may share such
