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Department of PROPERTY AND PROCUREMENT Government of the Virgin Islands “Keeping The People’s House In Order” D E P A R T M E N T O F P R O P E R T Y A N D P R O C U R E M E N T APPLICATION TO LEASE REAL ESTATE Application Date: ______________________________ Business Type : _______________________________ Business EIN No.: _____________________________ Telephone Number: ___________________________ Email Address: _______________________________ DUNS No.: ___________________________________ Referred by: __________________________________ 1. APPLICANT (Individual/Company Name): ___________________________________________ ___________________________________________ 2. CONTACT PERSON: Name: ______________________________________ Position: ____________________________________ Telephone: __________________________________ Cellular: ____________________________________ Email Address: ______________________________ 3. PHYSICAL ADDRESS: ___________________________________________ ___________________________________________ ___________________________________________ City State Zip Code 4. MAILING ADDRESS: ____________________________________________ ____________________________________________ ___________________________________________ City State Zip Code 5. COMPANY DATA: Type of Business: Date Established: ________________________________ Date Operations Began: __________________________ 6. CURRENT FACILITY LOCATION: Owned: _______________________________________ Leased: _______________________________________ Current Lessor/Landlord: __________________________ Monthly Lease/Rent: _____________________________ Length of Contract: _____________________________ 7. TAX EXEMPTION: a. Have you ever applied for tax exemption? Yes No b: If yes, when? __________________________________ c: If your business receives tax exemption, please list: ______________________________________________ ______________________________________________ Projected Growth: ______________________________ INITIALS: __________ Rev. 7/1/2020 8. BANKING AND COMMERCIAL REFERENCES: a. Include banking references and at least four (4) banking and/or commercial references. Please indicate the account numbers, references and the complete address. __________________________________________________________________________________________ __________________________________________________________________________________________ _________________________________________________________________________________________ __________________________________________________________________________________________ 1. 2. 3. 4. Name Account Number or Reference Mailing Address Telephone Non Profit Limited Liability Company Partnership Corporation Sole Proprietorship Other __________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ ________________________________________________________________________________________________ 9. NAMES OF OWNER(S)/STOCKHOLDER(S): b. Does the applicant, guarantor(s), stockholder(s), or officers have, or ever had, a pending application with any of the entities mentioned below? INITIALS: __________ 1. 2. 3. 4. 5. ________________________________________________________________________________________________ ________________________________________________________________________________________________ _______________________________________________________________________________________________ ________________________________________________________________________________________________ Name Financial Institution Account Number Title/Position Ownership % Email Year Telephone Original Amount Small Business Development Agency Government Development Bank Small Business Administration Commercial and Agricultural Credit Other (Please Indicate) 1. 2. 3. 4. 5. If you answered “Yes” to questions 9 through 11, please explain below or on a separate sheet of paper. 10. JUDICIAL LAWSUITS, TAX LAWSUIT OR BANKRUPTCY a. Is there any lawsuit pending or filed against the company, business, its owner(s), stakeholder(s), guarantor(s), or company officer(s)? Yes No If “YES” explain or give details: ______________________________________________________________________ _____________________________________________________________________________________________ b. Have the firm, its main stockholder(s), guarantor(s), officers or the business owner(s) ever been subject to bankruptcy or insolvency proceedings? Yes No If “YES” explain or give details: ______________________________________________________________________ _____________________________________________________________________________________________ c. Do you owe any income or property taxes? Yes No If “YES” explain or give details: ______________________________________________________________________ _____________________________________________________________________________________________ NOTE: You must submit certification from the Bureau of Internal Revenue and Office of the Lieutenant Governor’s Tax Assessor’s Office or copies of paid property tax bills. 11. Have the principal(s), stakeholder(s), guarantor(s) or officers ever been convicted of any financial crime? Yes No If “YES” explain or give details: ______________________________________________________________________ _____________________________________________________________________________________________ Department of PROPERTY AND PROCUREMENT Government of the Virgin Islands “Keeping The People’s House In Order” D E P A R T M E N T O F P R O P E R T Y A N D P R O C U R E M E N T APPLICATION TO LEASE REAL ESTATE Rev. 7/1/2020 Department of PROPERTY AND PROCUREMENT Government of the Virgin Islands “Keeping The People’s House In Order” D E P A R T M E N T O F P R O P E R T Y A N D P R O C U R E M E N T INITIALS: __________ APPLICATION TO LEASE REAL ESTATE Rev. 7/1/2020 12. Does any officer(s), principal(s), stockholder(s), guarantor(s) or business owner(s) currently work for the Government of the Virgin Islands? Yes No If “YES” explain or give details: ___________________________________________________________________ ________________________________________________________________________________________________ 13. EXPERIENCES: Provide a brief description of management’s experience in the industry: 14. DEVELOPMENT DETAILS: Estimated Costs of Investment: (a) Labor _______________________________________________ (b) Improvement ______________________________________________ (c) Total ______________________________________________ Funding source(s) for investment: Parcel # of Interest: Quantity of Land or Space needed(Acre/Sq Ft): Property Specification Needed: Undeveloped Land Office Space Retail Warehouse Location Desired: East End Central West End North Side South Side Required Zoning: Business & Commercial Industrial Residential Waterfront Agricultural Is a Variance needed? Yes No If YES explain: ________________________________________________________________________________ ________________________________________________________________________________________________ Estimated Size of Facility and Description (include applicable drawings/maps with application): Department of PROPERTY AND PROCUREMENT Government of the Virgin Islands “Keeping The People’s House In Order” D E P A R T M E N T O F P R O P E R T Y A N D P R O C U R E M E N T INITIALS: __________ APPLICATION TO LEASE REAL ESTATE Project plan and timetable: Number of jobs this project will create: Temporary Jobs Permanent Jobs Construction/Build Out Management Management Service Service Estimated gross income for the past five (5) years of operation (Attach Financial Statements and Prospectus (Three Years)): 20 _______ 20 _______ 20 _______ 20 _______ 20 _______ Additional Information: 15. SUPPORTING DOCUMENTS CHECK LIST (The documents below are mandatory for a swift and complete evaluation of your application.) Business License Articles of Incorporation and Organization Certificate of Partnership Formation Certificate of Good Standing Trade Name Certificate 501(C)(3) (Non Profits only) Business Plan including Prospectus Financial Statement - Existing Business Corporate Resolution - Empowering Signatory Architectural Site Plan or Layout Credit Report of all Owners (Transunion, Equifax or Experian) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Rev. 7/1/2020 Department of PROPERTY AND PROCUREMENT Government of the Virgin Islands “Keeping The People’s House In Order” D E P A R T M E N T O F P R O P E R T Y A N D P R O C U R E M E N T INITIALS: __________ APPLICATION TO LEASE REAL ESTATE 16. APPLICANT DECLARATION AND CONSENT I/We declare that all of the information contained is accurate and complete. I/We understand and agree that if any of the information is found to be false or incomplete, the Government of the U.S. Virgin Islands will have the right to reject this application and/or terminate the Lease Agreement resulting from this Application with immediate effect . I/We hereby authorize the Department of Property and Procurement and its officers to conduct any credit/reference checks on me/us to verify the information with any third party including Landlords, Banks, Creditors or other persons. INITIALS: __________ If you do not understand or agree with these conditions, please do not proceed with submitting this application. 17. SUBMITTED BY: Print Name: _______________________________________ Title: _____________________________ Signature: ________________________________________ Date: _____________________________ 18. GOVERNMENT DISCLAIMER: All non-confidential and non-proprietary information furnished is subject to public disclosure under the Virgin Islands Public Records Act. Any confidential or proprietary information should be clearly marked as such. APPROVED DISAPPROVED ___________________________________ _______________________ LISA M. ALEJANDRO DATE COMMISSIONER DEPARTMENT OF PROPERTY & PROCUREMENT Rev. 10/9/2020 Completed applications and supporting documentation shall be submitted to the Division of Property via email at property@dpp.vi.gov. SUBMIT SIGN