DEVELOPER’S STATEMENT OF QUALIFICATIONS AND FINANCIAL RESPONSIBILITY
Kindly answer the following questions, which will be utilized in the evaluation of the proposed Developer. All questions must be addressed. If the answer is “None” or “Not Applicable,” please so indicate. If space on this form is inadequate for any requested information, it should be furnished on a separate page and referred to under the appropriate numbered item on the form. 1. a. b. c. d. 2. Name of Developer:1 Address of Developer: Email Address: Phone Number:
The land on which the Developer proposes to enter into a contract lease or agreement of sale is described as follows:2 Is the Developer a subsidiary of or affiliated with any other corporation or corporations or any other firm or firms? ( ) Yes ( ) No
3.
If Yes, list each such corporation or firm by name and address, specify its relationship to the Developer and identify the officers and directors or trustees common to the Developer and such other corporation or firm. 4. a. The current financial condition of the Developer, as of reflected in the attached financial statement. ,2008 is as
(Note: the certified financial statement must show the assets and the liabilities, including contingent liabilities fully itemized in accordance with accepted accounting standards and based on a proper audit. If the date of the certified financial statement preceded the date of this submission by more than six (6) months, also attach an interim balance sheet not more than sixty (60) days old.) b. Name and address of auditor of public accounting who performed the audit on which said financial statement is based:
5.
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The Developer is encouraged to supply any information on the credit rating and credit history of the Developer and each participant. The undersigned, on behalf of the
Developer as used herein shall include all ownership interest, both legal and equitable, in the Project. The answer to this question should identify all persons or entities having, or that will have, an ownership interest in the project. Any convenient means of identifying the land (such as block and lot numbers or street boundaries) is sufficient. A description by metes and bounds or other technical description is acceptable, but not required.
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Developer and each participant. The undersigned, on behalf of the Developer, does hereby consent to any and all credit investigations that the City deems appropriate and further authorizes the City and Consultant to obtain any and all credit reports on each of the Principals of the Developer.3 6. a. Has any Principal of the Developer been the subject as debtor, of any proceedings under the Bankruptcy Code of the United States within the past ten (10) years? Has the Developer or any of the Principals of the Developer been charged in court with any felony within the past ten (10) years?
b.
7.
Other projects with the City of Philadelphia or its related agencies, in which the Developer or any of the principals of the Developer is or has been the Developer, or has otherwise been significantly involved. Does any member of the governing body of the City of Philadelphia in which the development site is situated or any other public official of the City of Philadelphia, who exercises or might exercise any functions or responsibilities in the review or approval of the carrying out of the project under which the land covered by the Developer’s proposal is being made available, have any direct or indirect personal interest in the Developer or in the development or rehabilitation of the property upon the basis of such proposal? ( ) Yes ( ) No
8.
If Yes, explain: 9. Statements and other evidence of the Developer’s qualifications and financial responsibility (other than the financial statement referred to in 4(a) are attached hereto and hereby made a part hereof as follows:
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Principals of the Developer as referred to in this document shall mean the Developer; its parent corporation (if any); any subsidiary or affiliated corporation of the Developer; its principal partners, investors, shareholders, associates or other interested parties.
10. 11.
Date business was established:__________________________________________. In the spaces below, provide information on all development projects undertaken by the developer within the last five (5) years. (Additional sheets may be added if necessary.) a. Development Name/Address: __________________________________ __________________________________ Owner Name/Address: __________________________________ __________________________________ Dates Begun/Completed: __________________________________ __________________________________ No. Residential Units & Type: __________________________________ __________________________________ Other Development Size/Type: __________________________________ __________________________________ General Contractor: __________________________________ __________________________________ Development Cost: __________________________________ __________________________________ Construction Cost: __________________________________ __________________________________ Financing - % Equity: % Mortgage(s): % Public (program): Principal Mortgagor: __________________________________ __________________________________ __________________________________ __________________________________
b.
Development Name/Address:
__________________________________ __________________________________
Owner Name/Address:
__________________________________ __________________________________
Dates Begun/Completed:
__________________________________ __________________________________
No. Residential Units & Type:
__________________________________ __________________________________
Other Development Size/Type:
__________________________________ __________________________________
General Contractor:
__________________________________ __________________________________
Development Cost:
__________________________________ __________________________________
Construction Cost:
__________________________________ __________________________________
Financing - % Equity: % Mortgage(s): % Public (program): Principal Mortgagor:
__________________________________ __________________________________ __________________________________ __________________________________
c.
Development Name/Address:
__________________________________ __________________________________
Owner Name/Address:
__________________________________ __________________________________
Dates Begun/Completed:
__________________________________ __________________________________
No. Residential Units & Type:
__________________________________ __________________________________
Other Development Size/Type:
__________________________________ __________________________________
General Contractor:
__________________________________ __________________________________
Development Cost:
__________________________________ __________________________________
Construction Cost:
__________________________________ __________________________________
Financing - % Equity: % Mortgage(s): % Public (program): Principal Mortgagor:
__________________________________ __________________________________ __________________________________ __________________________________
d.
Development Name/Address:
__________________________________ __________________________________
Owner Name/Address:
__________________________________ __________________________________
Dates Begun/Completed:
__________________________________ __________________________________
No. Residential Units & Type:
__________________________________ __________________________________
Other Development Size/Type:
__________________________________ __________________________________
General Contractor:
__________________________________ __________________________________
Development Cost:
__________________________________ __________________________________
Construction Cost:
__________________________________ __________________________________
Financing - % Equity: % Mortgage(s): % Public (program): Principal Mortgagor:
__________________________________ __________________________________ __________________________________ __________________________________
DEVELOPER’S STATEMENT OF QUALIFICATIONS AND FINANCIAL RESPONSIBILITY AFFIDAVIT4
_____________________________________________________, being duly sworn according to law deposes and says, with the intention of being legally bound hereby, that he/she has personally reviewed the information contained herein and that the statements contained in the foregoing Developer’s Statement of Qualifications and Financial Responsibility are true and correct to the best of his/her knowledge and belief; that he/she understands that if he/she knowingly makes any false statements or material omissions herein, he/she is subject to such penalties as now or may in the future be prescribed by Statute, Ordinance, common law or regulations including the penalty for perjury.
WITNESS:
DEVELOPER:
___________________________________ Signature
____________________________________ Signature
___________________________________ Address
____________________________________ Title
____________________________________ Address
Sworn to and subscribed Before me this day of , 20___
___________________________________ Notary Public
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If the Developer is an individual, this statement should be signed by such individual; if a partnership, by one of the partners; if a corporation or other entity, by one of its chief officers having knowledge of the facts by this statement