Court filing
Exhibit - United States v. Eric Shibley
Summary
Exhibit in United States v. Eric Shibley, Case 2:20-cr-00174-JCC, filed November 26, 2021 as Document 137-5. The 34-page exhibit opens with a Paycheck Protection Program Borrower Application Form, SBA Form 2483 (04/20), for SFC LLC, marked Government Exhibit No. 14. The form lists Eric R Shibley as manager and 100% owner and records an average monthly payroll of $37,600 and a loan request of $94,000. It carries the applicant certifications, including the false-statement penalty notices under 18 USC 1001 and 18 USC 1014. The signature block is dated April 25, 2020 and prints the name Eric R Shibley, Manager, followed by the form's instructions and statutory notices.
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Full text
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 1 of 34
Paycheck Protection Program OMB Control No.: 3245-0407
Borrower Application Form Expiration Date: 09/30/2020
Check One: Sole proprietor Partnership
( C-Corp S-Corp LLC
DBA or Tradename if Applicable
Independent contractor Eligible self-employed individual
501(c)(3) nonprofit 501(c)(19) veterans organization
Tribal business (sec. 31(b)(2)(C) of Small Business Act) Other
Business Legal Name
SFC LLC
Business Address Business TIN (EIN, SSN) Business Phone
4700 36th Ave SW Seattle WA 98126 3580 206)
( -
938-4291
Primary Contact Email Address
Eric Shibley shibley98271@gmail.com
37,600 94,000 6
Average Monthly Payroll: $ x 2.5 + EIDL, Net of $ Number of Employees:
Advance (if Applicable)
Equals Loan Request:
Purpose of the loan
(select more than one): ☐Payroll ☐Lease / Mortgage Interest ☐Utilities ☐Other (explain):__________________
Applicant Ownership
List all owners of 20% or more of the equity of the Applicant. Attach a separate sheet if necessary.
Owner Name Title Ownership % TIN (EIN, SSN) Address
Eric R Shibley Manager 100 -5264 4700 36th Ave SW Seattle WA 98126
If questions (1) or (2) below are answered “Yes,” the loan will not be approved.
Question Yes No
1. Is the Applicant or any owner of the Applicant presently suspended, debarred, proposed for debarment, declared ineligible,
voluntarily excluded from participation in this transaction by any Federal department or agency, or presently involved in any
bankruptcy?
☐☐
2. Has the Applicant, any owner of the Applicant, or any business owned or controlled by any of them, ever obtained a direct or ☐☐
guaranteed loan from SBA or any other Federal agency that is currently delinquent or has defaulted in the last 7 years and
caused a loss to the government?
3. Is the Applicant or any owner of the Applicant an owner of any other business, or have common management with, any other ☐☐
business? If yes, list all such businesses and describe the relationship on a separate sheet identified as addendum A.
4. Has the Applicant received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020? If yes, ☐☐
provide details on a separate sheet identified as addendum B.
If questions (5) or (6) are answered “Yes,” the loan will not be approved.
Question Yes No
5. Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject
to an indictment, criminal information, arraignment, or other means by which formal criminal charges are ☐ ☐
brought in any jurisdiction, or presently incarcerated, or on probation or parole?
ers
Initial here to confirm your response to question 5 →
6. Within the last 5 years, for any felony, has the Applicant (if an individual) or any owner of the Applicant 1)
been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been
placed on any form of parole or probation (including probation before judgment)?
☐ ☐
Initial here to confirm your response to question 6 → ers
7. Is the United States the principal place of residence for all employees of the Applicant included in the
Applicant’s payroll calculation above?
☐ ☐
8. Is the Applicant a franchise that is listed in the SBA’s Franchise Directory? ☐ ☐
FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000428
1
SBA Form 2483 (04/20) U.S. v. Shibley
CR20-174 JCC DOJ-01-0000003395
Government Exhibit No. 14
Admitted ________________
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 2 of 34
Paycheck Protection Program
Borrower Application Form
By Signing Below, You Make the Following Representations, Authorizations, and Certifications
CERTIFICATIONS AND AUTHORIZATIONS
I certify that:
I have read the statements included in this form, including the Statements Required by Law and Executive Orders, and I understand them.
The Applicant is eligible to receive a loan under the rules in effect at the time this application is submitted that have been issued by the
Small Business Administration (SBA) implementing the Paycheck Protection Program under Division A, Title I of the Coronavirus
Aid, Relief, and Economic Security Act (CARES Act) (the Paycheck Protection Program Rule).
The Applicant (1) is an independent contractor, eligible self-employed individual, or sole proprietor or (2) employs no more
than the greater of 500 or employees or, if applicable, the size standard in number of employees established by the SBA in 13
C.F.R. 121.201 for the Applicant’s industry.
I will comply, whenever applicable, with the civil rights and other limitations in this form.
All SBA loan proceeds will be used only for business-related purposes as specified in the loan application and consistent with the
Paycheck Protection Program Rule.
To the extent feasible, I will purchase only American-made equipment and products.
The Applicant is not engaged in any activity that is illegal under federal, state or local law.
Any loan received by the Applicant under Section 7(b)(2) of the Small Business Act between January 31, 2020 and April 3, 2020 was
for a purpose other than paying payroll costs and other allowable uses loans under the Paycheck Protection Program Rule.
For Applicants who are individuals: I authorize the SBA to request criminal record information about me from criminal justice agencies for the
purpose of determining my eligibility for programs authorized by the Small Business Act, as amended.
CERTIFICATIONS
The authorized representative of the Applicant must certify in good faith to all of the below by initialing next to each one:
red
_____ The Applicant was in operation on February 15, 2020 and had employees for whom it paid salaries and payroll taxes or paid independent
contractors, as reported on Form(s) 1099-MISC.
ers
_____ Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.
ers
_____ The funds will be used to retain workers and maintain payroll or make mortgage interest payments, lease payments, and utility payments,
as specified under the Paycheck Protection Program Rule; I understand that if the funds are knowingly used for unauthorized purposes,
the federal government may hold me legally liable, such as for charges of fraud.
ers
_____ The Applicant will provide to the Lender documentation verifying the number of full-time equivalent employees on the Applicant’s
payroll as well as the dollar amounts of payroll costs, covered mortgage interest payments, covered rent payments, and covered utilities
for the eight-week period following this loan.
ers
_____ I understand that loan forgiveness will be provided for the sum of documented payroll costs, covered mortgage interest payments,
covered rent payments, and covered utilities, and not more than 25% of the forgiven amount may be for non-payroll costs.
ers
_____ During the period beginning on February 15, 2020 and ending on December 31, 2020, the Applicant has not and will not receive another
loan under the Paycheck Protection Program.
ers
_____ I further certify that the information provided in this application and the information provided in all supporting documents and
forms is true and accurate in all material respects. I understand that knowingly making a false statement to obtain a guaranteed loan
from SBA is punishable under the law, including under 18 USC 1001 and 3571 by imprisonment of not more than five years and/or a
fine of up to $250,000; under 15 USC 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if
submitted to a federally insured institution, under 18 USC 1014 by imprisonment of not more than thirty years and/or a fine of not
more than $1,000,000.
ers
_____ I acknowledge that the lender will confirm the eligible loan amount using required documents submitted. I understand,
acknowledge and agree that the Lender can share any tax information that I have provided with SBA's authorized representatives,
including authorized representatives of the SBA Office of Inspector General, for the purpose of compliance with SBA Loan
Program Requirements and all SBA reviews.
04/25/2020
_________________________________________________________ ________________________
Signature of Authorized Representative of Applicant Date
Eric R Shibley Manager
Print Name Title
FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000429
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SBA Form 2483 (04/20)
DOJ-01-0000003396
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 3 of 34
Paycheck Protection Program
Borrower Application Form
Purpose of this form:
This form is to be completed by the authorized representative of the Applicant and submitted to your SBA Participating Lender. Submission of
the requested information is required to make a determination regarding eligibility for financial assistance. Failure to submit the information
would affect that determination.
Instructions for completing this form:
With respect to “purpose of the loan,” payroll costs consist of compensation to employees (whose principal place of residence is the United
States) in the form of salary, wages, commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tips
or, in the absence of such records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental, family, medical, or
sick leave; allowance for separation or dismissal; payment for the provision of employee benefits consisting of group health care coverage,
including insurance premiums, and retirement; payment of state and local taxes assessed on compensation of employees; and for an
independent contractor or sole proprietor, wage, commissions, income, or net earnings from self-employment or similar compensation.
For purposes of calculating “Average Monthly Payroll,” most Applicants will use the average monthly payroll for 2019, excluding costs over
$100,000 on an annualized basis for each employee. For seasonal businesses, the Applicant may elect to instead use average monthly payroll
for the time period between February 15, 2019 and June 30, 2019, excluding costs over $100,000 on an annualized basis for each employee.
For new businesses, average monthly payroll may be calculated using the time period from January 1, 2020 to February 29, 2020, excluding
costs over $100,000 on an annualized basis for each employee.
If Applicant is refinancing an Economic Injury Disaster Loan (EIDL): Add the outstanding amount of an EIDL made between January 31, 2020
and April 3, 2020, less the amount of any “advance” under an EIDL COVID-19 loan, to Loan Request as indicated on the form.
All parties listed below are considered owners of the Applicant as defined in 13 CFR § 120.10, as well as “principals”:
For a sole proprietorship, the sole proprietor;
For a partnership, all general partners, and all limited partners owning 20% or more of the equity of the firm;
For a corporation, all owners of 20% or more of the corporation;
For limited liability companies, all members owning 20% or more of the company; and
Any Trustor (if the Applicant is owned by a trust).
Paperwork Reduction Act – You are not required to respond to this collection of information unless it displays a currently valid OMB
Control Number. The estimated time for completing this application, including gathering data needed, is 8 minutes. Comments about this time
or the information requested should be sent to : Small Business Administration, Director, Records Management Division, 409 3rd St., SW,
Washington DC 20416., and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Washington DC
20503.
Privacy Act (5 U.S.C. 552a) – Under the provisions of the Privacy Act, you are not required to provide your social security number. Failure to
provide your social security number may not affect any right, benefit or privilege to which you are entitled. (But see Debt Collection Notice
regarding taxpayer identification number below.) Disclosures of name and other personal identifiers are required to provide SBA with
sufficient information to make a character determination. When evaluating character, SBA considers the person’s integrity, candor, and
disposition toward criminal actions. Additionally, SBA is specifically authorized to verify your criminal history, or lack thereof, pursuant to
section 7(a)(1)(B), 15 USC Section 636(a)(1)(B) of the Small Business Act (the Act).
Disclosure of Information – Requests for information about another party may be denied unless SBA has the written permission of the
individual to release the information to the requestor or unless the information is subject to disclosure under the Freedom of Information Act.
The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use is the disclosure of
information maintained in SBA’s system of records when this information indicates a violation or potential violation of law, whether civil,
criminal, or administrative in nature. Specifically, SBA may refer the information to the appropriate agency, whether Federal, State, local or
foreign, charged with responsibility for, or otherwise involved in investigation, prosecution, enforcement or prevention of such violations.
Another routine use is disclosure to other Federal agencies conducting background checks but only to the extent the information is relevant to
the requesting agencies' function. See, 74 F.R. 14890 (2009), and as amended from time to time for additional background and other routine
uses. In addition, the CARES Act, requires SBA to register every loan made under the Paycheck Protection Act using the Taxpayer
Identification Number (TIN) assigned to the borrower.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) – SBA must obtain your taxpayer
identification number when you apply for a loan. If you receive a loan, and do not make payments as they come due, SBA may: (1) report the
status of your loan(s) to credit bureaus, (2) hire a collection agency to collect your loan, (3) offset your income tax refund or other amounts
due to you from the Federal Government, (4) suspend or debar you or your company from doing business with the Federal Government, (5)
refer your loan to the Department of Justice, or (6) foreclose on collateral or take other action permitted in the loan instruments.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) – The Right to Financial Privacy Act of 1978, grants SBA access rights to
financial records held by financial institutions that are or have been doing business with you or your business including any financial
FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000430
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SBA Form 2483 (04/20)
DOJ-01-0000003397
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 4 of 34
Paycheck Protection Program
Borrower Application Form
institutions participating in a loan or loan guaranty. SBA is only required provide a certificate of its compliance with the Act to a financial
institution in connection with its first request for access to your financial records. SBA's access rights continue for the term of any approved
loan guaranty agreement. SBA is also authorized to transfer to another Government authority any financial records concerning an approved
loan or loan guarantee, as necessary to process, service or foreclose on a loan guaranty or collect on a defaulted loan guaranty.
Freedom of Information Act (5 U.S.C. 552) – Subject to certain exceptions, SBA must supply information reflected in agency files and
records to a person requesting it. Information about approved loans that will be automatically released includes, among other things, statistics
on our loan programs (individual borrowers are not identified in the statistics) and other information such as the names of the borrowers (and
their officers, directors, stockholders or partners), the collateral pledged to secure the loan, the amount of the loan, its purpose in general terms
and the maturity. Proprietary data on a borrower would not routinely be made available to third parties. All requests under this Act are to be
addressed to the nearest SBA office and be identified as a Freedom of Information request.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.) – The Occupational Safety and Health Administration (OSHA) can require
businesses to modify facilities and procedures to protect employees. Businesses that do not comply may be fined, forced to cease operations,
or prevented from starting operations. Signing this form is certification that the applicant, to the best of its knowledge, is in compliance with
the applicable OSHA requirements, and will remain in compliance during the life of the loan.
Civil Rights (13 C.F.R. 112, 113, 117) – All businesses receiving SBA financial assistance must agree not to discriminate in any business
practice, including employment practices and services to the public on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117 of
SBA Regulations. All borrowers must display the "Equal Employment Opportunity Poster" prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691) – Creditors are prohibited from discriminating against credit applicants on the basis of race,
color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into a binding contract); because all
or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right
under the Consumer Credit Protection Act.
Debarment and Suspension Executive Order 12549; (2 CFR Part 180 and Part 2700) – By submitting this loan application, you certify
that neither the Applicant or any owner of the Applicant have within the past three years been: (a) debarred, suspended, declared ineligible or
voluntarily excluded from participation in a transaction by any Federal Agency; (b) formally proposed for debarment, with a final
determination still pending; (c) indicted, convicted, or had a civil judgment rendered against you for any of the offenses listed in the
regulations or (d) delinquent on any amounts owed to the U.S. Government or its instrumentalities as of the date of execution of this
certification.
FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000431
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SBA Form 2483 (04/20)
DOJ-01-0000003398
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1<6>598;"2;?7:<=7"41."'&+-3$3/#&(3(#(,)*#,&',#/)3%(30(%&3/
NOTE TERMS:
Maturity: This Note will mature 2 years from date of Note.
Repayment Terms:
The interest rate is 1.0% per year. The interest rate may only be changed in accordance with SOP 50 10, the
CARES Act, or guidance established by the SBA or U.S. Treasury.
Payments of the Loan shall be deferred for the first six (6) months following disbursement of the Loan.
Borrower must pay principal and interest payments every month, beginning seven (7) months following the
date of the Note; payments must be made on the same day as the date of the Note in the months they are due.
Interest shall continue to accrue during the six (6) month deferment.
Lender will apply each installment payment first to pay interest accrued to the day Lender receives the
payment, then to bring principal current and will apply any remaining balance to reduce principal.
This Loan is made under the provisions of the PPP, 7(a) Loan Program and the CARES Act. The principal
under this Note may be reduced or forgiven in accordance with the loan forgiveness provisions of the CARES
Act and regulations or requirements established by SBA and the U.S. Treasury. The principal of this Note
is not be deemed forgiven or reduced until documented in a writing, signed by Lender or the SBA. Interest
under this loan will not be forgiven but payments for interest may be made by SBA.
Lender shall notify Borrower of its determination of debt forgiveness and of any remaining balance which
bWP[[ R^]cX]dT c^ QT SdT P]S ^fX]V d]STa cWT E^cT &cWT jHT\PX]X]V FQ[XVPcX^]bk'* 9^aa^fTa \dbc _Ph _aX]RX_P[
and interest payments on the Remaining Obligations, in an amount calculated by the Lender, which will amortize
the Remaining Obligations, plus interest, amortized over the remaining eighteen (18) months of this Note.
Principal and interest payments on the Remaining Obligations shall begin on the date which is seven (7) months
from the date of this Note and shall continue on the same date of each of the seventeen
(17) consecutive months thereafter. BORROWER AGREES THAT THE MONTHLY PRINCIPAL AND
INTEREST PAYMENTS PROVIDED BY LENDER TO BORROWER TO SATISFY THE REMAINING
OBLIGATIONS SHALL BE BINDING UPON THE BORROWER AND GIVEN THE SAME LEGAL
EFFECT AS IF THE SPECIFIC AMOUNT OF THE PRINCIPAL AND INTEREST PAYMENTS WERE
SET FORTH IN THIS NOTE.
Loan Prepayment:
No prepayment fee will be due under the terms of this Note.
All remaining principal and accrued interest is due and payable 2 years from date of Note.
4. DEFAULT:
Borrower is in default under this Note if Borrower does not make a payment when due under this Note, or if Borrower:
A. Fails to do anything required by this Note;
B. Defaults on any other loan with Lender;
C. Does not disclose, or anyone acting on their behalf does not disclose, any material fact to Lender or
SBA;
D. Makes, or anyone acting on their behalf makes, a materially false or misleading representation to
Lender or SBA;
E. Defaults on any loan or agreement with another creditor, if Lender believes the default may materially
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F. Fails to pay any taxes when due;
G. Becomes the subject of a proceeding under any bankruptcy or insolvency law;
H. Has a receiver or liquidator appointed for any part of their business or property;
I. Makes an assignment for the benefit of creditors;
J. Has any adverse change in financial condition or business operation that Lender believes may materially
affect BorrowTalb PQX[Xch c^ _Ph cWXb E^cT7
K. Reorganizes, merges, consolidates, or otherwise changes ownership or business structure without
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L. Becomes the subject of a civil or criminal action that Lender believes may materially afUTRc 9^aa^fTalb
ability to pay this Note.
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5. C<E;<HlI H@>?JI @= J?<H< @I 8 ;<=8KCJ6
Without notice or demand and without giving up any of its rights, Lender may: A.
Require immediate payment of all amounts owing under this Note;
B. Collect all amounts owing from Borrower;
C. File suit and obtain judgment;
6. C<E;<HlI ><E<H8C GFM<HI6
MXcW^dc ]^cXRT P]S fXcW^dc 9^aa^fTalb R^]bT]c( CT]STa \Ph6
A. Incur expenses to collect amounts due under this Note, enforce the terms of this Note or any other Loan
Document. If Lender incurs such expenses, it may demand immediate repayment from Borrower or add
the expenses to the principal balance;
B. Release anyone obligated to pay this Note;
7. WHEN FEDERAL LAW APPLIES:
When SBA is the holder, this Note will be interpreted and enforced under federal law, including SBA regulations.
Lender or SBA may use state or local procedures for filing papers, recording documents, giving notice, and other
purposes. By using such procedures, SBA does not waive any federal immunity from state or local control, penalty,
tax, or liability. As to this Note, Borrower may not claim or assert against SBA any local or state law to deny any
obligation, defeat any claim of SBA, or preempt federal law.
8. SUCCESSORS AND ASSIGNS:
Under this Note, Borrower includes the successors of Borrower, and Lender includes its successors and assigns.
9. GENERAL PROVISIONS:
A. All individuals and entities signing this Note are jointly and severally liable.
B. Borrower waives all suretyship defenses.
C. Lender may exercise any of its rights separately or together, as many times and in any order it chooses.
Lender may delay or forgo enforcing any of its rights without giving up any of them.
D. Borrower may not use an oral statement of Lender or SBA to contradict or alter the written terms of this
Note.
E. If any part of this Note is unenforceable, all other parts remain in effect.
F. To the extent allowed by law, Borrower waives all demands and notices in connection with this Note,
including presentment, demand, protest, and notice of dishonor. Borrower also waives any defenses based
upon any claim that Lender did not obtain any guarantee.
10. DISCLOSURES
A. This Loan is made under the terms and conditions of the PPP and SBA 7(a) Loan Program and shall be
subject to current and future regulations, guidance, statutory provisions or rules governing the PPP or
SBA 7(a) Loan Programs.
B. Forgiveness of principal under this Loan may only granted in accordance with the PPP and the CARES
Act, Lender has made no promise, guarantee, or representation to Borrower regarding forgiveness of the
principal or accrued interest under this Loan and Borrower may not rely on any statement or representation
from Lender with respect to loan forgiveness. Borrower understands that forgiveness is only available for
principal that is used of the limited purposes that qualify for forgiveness under SBA requirements.
C. The Paycheck Protection Program Borrower Application Form (SBA Form 2483) contains certain
statements, including the Statements Required by Law and Executive Orders and the Debarment and
Suspension Executive Order and by executing below the Borrower is confirming to have read and
understood the statements included in the Application Form.
D. Borrower understands and acknowledges that not more than 25% of the amount forgiven can be
attributable to non-payroll costs.
E. Borrower understands and agrees that forgiveness is not automatic and Borrower must request it.
Page 3 of 4
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1<6>598;"2;?7:<=7"41."'&+-3$3/#&(3(#(,)*#,&',#/)3%(30(%&3/
11. CERTIFICATIONS
By signing below, Borrower certifies, represents, warrants, and agrees:
A. All certifications, authorizations, and representations made by Borrower and/or the authorized
representative of Borrower in the Paycheck Protection Program Borrower Application Form (SBA Form
2483) submitted to Lender remain true and accurate as of the date of this Note.
B. The proceeds of such Loan are intended to be used for payroll costs; costs related to the continuation of
group health care benefits during periods of paid sick, medical, or family leave, and insurance premiums;
employee salaries, commissions, or similar compensations; payments of interest on mortgage obligations
(which shall not include any prepayment of or payment of principal on a mortgage obligation); rent
(including rent under a lease agreement); utilities; interest on any other debt obligations that were incurred
before February 15, 2020, and as otherwise permitted under the CARES Act, as amended and/or modified.
C. No parts of the proceeds of such Loan will be used for personal, family or household purposes.
D. The undersigned is exercising and will continue to exercise actual control over the managerial decisions
of the Borrower concerning the use of funds and/or credit to be derived from the Loan.
E. The undersigned hereby agrees to promptly correct any defect, error or omission, or provide any
documentation requested or required, upon request of Lender or SBA, which may be discovered in the
contents of any loan documentation, the application or in the execution or acknowledgment thereof, and
will execute, or re-execute, acknowledge and deliver such further instruments and do such further acts as
may be necessary or reasonably requested by Lender to satisfy the terms and conditions of this Loan,
and/or the requirements of PPP, SBA, or Treasury, as applicable.
F. The execution of this NotT P]S P]h aT[PcTS [^P] S^Rd\T]cb _aX^a c^ R^\_[TcX^] ^U P[[ ^U CT]STalb
conditions may be permitted as an accommodation to Borrower. Lender shall not be obligated to fund
the Loan until Lender receives and satisfies all of its loan conditions and requirements under applicable
rule or law and receives all documents it deems necessary, including but not limited to the satisfactory
evidence and documentation of payroll costs supporting the requested Loan and any forms to be
completed by Lender, including SBA Form 2484.
G. If the Borrower is an entity, the undersigned is authorized and empowered to execute and deliver this
Note to Lender, any required corporate or company action necessary to authorize the Loan has been duly
completed or performed, and the actions taken herein are hereby ratified and confirmed.
12. STATE-SPECIFIC PROVISIONS:
13. 9FHHFM<HlI E8D<&I' 8E; I@>E8JKH<&I'6
By signing below, each individual or entity becomes obligated under this Note as Borrower.
BORROWER:
_______________________
SFC LLC
By:___________________________________
Eric Shibley
____________, Manager
______________
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DOJ-01-0000003381
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FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000411
DOJ-01-0000003382
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 15 of 34
1<6>598;"2;?7:<=7"41."'&+-3$3/#&(3(#(,)*#,&',#/)3%(30(%&3/
FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000412
DOJ-01-0000003383
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 16 of 34
Certificate Of Completion
Envelope Id: 3279F0FA24F448568238A5F14FC412FA Status: Completed
Subject: Eric Shibley, Please DocuSign the SBA Note and ACH
Source Envelope:
Document Pages: 6 Signatures: 2 Envelope Originator:
Certificate Pages: 4 Initials: 0 Bryan Bacallao
AutoNav: Enabled 200 Connell Drive, Suite 4000
EnvelopeId Stamping: Enabled Berkeley Heights, NJ 07922
Time Zone: (UTC-05:00) Eastern Time (US & Canada) bryan.bacallao@knightcapitalfunding.com
IP Address: 13.110.14.8
Record Tracking
Status: Original Holder: Bryan Bacallao Location: DocuSign
6/2/2020 4:08:52 PM bryan.bacallao@knightcapitalfunding.com
Signer Events Signature Timestamp
Eric Shibley Sent: 6/2/2020 4:09:33 PM
shibley98271@gmail.com Viewed: 6/2/2020 4:11:21 PM
Manager Signed: 6/2/2020 7:09:27 PM
Security Level: Email, Account Authentication
(None) Signature Adoption: Pre-selected Style
Using IP Address: 73.109.30.232
Electronic Record and Signature Disclosure:
Accepted: 6/2/2020 4:11:21 PM
ID: 0e5f5209-2925-4aac-b6be-8eebdff595e1
Company Name: ReadyCap Lending, LLC
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 6/2/2020 4:09:33 PM
Certified Delivered Security Checked 6/2/2020 4:11:22 PM
Signing Complete Security Checked 6/2/2020 7:09:27 PM
Completed Security Checked 6/2/2020 7:09:27 PM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000316
DOJ-01-0000003293
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 17 of 34
,953><;:83"/53;<4"1:4"086:1>?<5"+8=39;=?<5"3<51>54";:*"(#'$#&$&$"'*&$*%)".-
.1<>85="16<554">;*",<83"078295@
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, ReadyCap Lending, LLC (we, us or Company) may be required by law to
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FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000317
DOJ-01-0000003294
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 18 of 34
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FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000318
DOJ-01-0000003295
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 19 of 34
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you.
FOIA CONFIDENTIAL TREATMENT REQUESTED ATH-RC_0000319
DOJ-01-0000003296
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 20 of 34
te 8 Paycheck Protection Program OMB Control No.: 3245-0407
ro Borrower Application Form Expiration Date: 09/30/2020
Check One: Q Sole proprietor QO Partnership QO C-Corp OS-Corp @ LLC DBA or Tradename if Applicable
QO Independent contractor UO) Eligible self-employed individual
(1 501(c)(3) nonprofit QO) 501(c)(19) veterans organization
U) Tribal business (sec. 31(b)(2)(C) of Small Business Act) UO Other
Business Legal Name
Eric R Shibley MD PLLC
Business Address Business TIN (EIN, SSN) Business Phone
4700 36th Ave SW WG 052 «= 2069384291
Primary Contact Email Address
Eric SHibley shibleymedical@outlook.com
Average Monthly Payroll: $ x 2.5 + EIDL, Net of $ Number of Employees:} 5
4 O O O O Advance (if Applicable) 1 0 0 0 6) 6)
Equals Loan Request:
Purpose of the loan
(select more than one): [=] Payroll ElLease / Mortgage Interest EJUtilities [=JOther (explain): employee benefits
Applicant Ownership
List all owners of 20% or more of the equity of the Applicant. Attach a separate sheet if necessary.
Owner Name Title Ownership % | TIN (EIN, SSN) Address
Eric R Shibley Manager 100 5344/4700 36th Ave SW Seattle §
Tf questions (1) or (2) below are answered “Yes,” the loan will not be approved.
| Question | Yes | No |
1. Is the Applicant or any owner of the Applicant presently suspended, debarred, proposed for debarment, declared ineligible,
voluntarily excluded from participation in this transaction by any Federal department or agency, or presently involved in any TC [m]
bankruptcy?
2. Has the Applicant, any owner of the Applicant, or any business owned or controlled by any of them, ever obtained a direct or L] =
guaranteed loan from SBA or any other Federal agency that is currently delinquent or has defaulted in the last 7 years and
caused a loss to the government?
f® oO
3. Is the Applicant or any owner of the Applicant an owner of any other business, or have common management with, any other
business? If yes, list all such businesses and describe the relationship on a separate sheet identified as addendum A.
4. Has the Applicant received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020? If yes, 0 [=]
provide details on a separate sheet identified as addendum B.
Tf questions (5) or (6) are answered “‘Yes,”’ the loan will not be approved.
| Question | Yes | No |
5. Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject 0 io
to an indictment, criminal information, arraignment, or other means by which formal criminal charges are
brought in any jurisdiction, or presently incarcerated, or on probation or parole?
ers
Initial here to confirm your response to question 5 >
6. Within the last 5 years, for any felony, has the Applicant (if an individual) or any owner of the Applicant 1)
been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been C] [|
placed on any form of parole or probation (including probation before judgment)?
Initial here to confirm your response to question6— €©FS
7. Is the United States the principal place of residence for all employees of the Applicant included in the
Applicant’s payroll calculation above?
8. Is the Applicant a franchise that is listed in the SBA’s Franchise Directory? U.S. v. Shibley
CR20-174 JCC
Government Exhibit No. 15
| Admitted
SBA Form 2483 (04/20)
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 21 of 34
Paycheck Protection Program
Borrower Application Form
By Signing Below, You Make the Following Representations, Authorizations, and Certifications
CERTIFICATIONS AND AUTHORIZATIONS
I certify that:
x I have read the statements included in this form, including the Statements Required by Law and Executive Orders, and I understand them.
x The Applicant is eligible to receive a loan under the rules in effect at the time this application is submitted that have been issued by the
Small Business Administration (SBA) implementing the Paycheck Protection Program under Division A, Title I of the Coronavirus
Aid, Relief, and Economic Security Act (CARES Act) (the Paycheck Protection Program Rule).
x The Applicant (1) is an independent contractor, eligible self-employed individual, or sole proprietor or (2) employs no more
than the greater of 500 or employees or, if applicable, the size standard in number of employees established by the SBA in 13
C.F.R. 121.201 for the Applicant’s industry.
x I will comply, whenever applicable, with the civil rights and other limitations in this form.
x All SBA loan proceeds will be used only for business-related purposes as specified in the loan application and consistent with the
Paycheck Protection Program Rule.
x To the extent feasible, I will purchase only American-made equipment and products.
x The Applicant is not engaged in any activity that is illegal under federal, state or local law.
x Any loan received by the Applicant under Section 7(b)(2) of the Small Business Act between January 31, 2020 and April 3, 2020 was
for a purpose other than paying payroll costs and other allowable uses loans under the Paycheck Protection Program Rule.
For Applicants who are individuals: I authorize the SBA to request criminal record information about me from criminal justice agencies for the
purpose of determining my eligibility for programs authorized by the Small Business Act, as amended.
CERTIFICATIONS
The authorized representative of the Applicant must certify in good faith to all of the below by initialing next to each one:
ers
_____ The Applicant was in operation on February 15, 2020 and had employees for whom it paid salaries and payroll taxes or paid independent
contractors, as reported on Form(s) 1099-MISC.
ers
_____ Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.
ers
_____ The funds will be used to retain workers and maintain payroll or make mortgage interest payments, lease payments, and utility payments,
as specified under the Paycheck Protection Program Rule; I understand that if the funds are knowingly used for unauthorized purposes,
the federal government may hold me legally liable, such as for charges of fraud.
ers
_____ The Applicant will provide to the Lender documentation verifying the number of full-time equivalent employees on the Applicant’s
payroll as well as the dollar amounts of payroll costs, covered mortgage interest payments, covered rent payments, and covered utilities
for the eight-week period following this loan.
ers
_____ I understand that loan forgiveness will be provided for the sum of documented payroll costs, covered mortgage interest payments,
covered rent payments, and covered utilities, and not more than 25% of the forgiven amount may be for non-payroll costs.
ers
_____ During the period beginning on February 15, 2020 and ending on December 31, 2020, the Applicant has not and will not receive another
loan under the Paycheck Protection Program.
ers
_____ I further certify that the information provided in this application and the information provided in all supporting documents and
forms is true and accurate in all material respects. I understand that knowingly making a false statement to obtain a guaranteed loan
from SBA is punishable under the law, including under 18 USC 1001 and 3571 by imprisonment of not more than five years and/or a
fine of up to $250,000; under 15 USC 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if
submitted to a federally insured institution, under 18 USC 1014 by imprisonment of not more than thirty years and/or a fine of not
more than $1,000,000.
ers
_____ I acknowledge that the lender will confirm the eligible loan amount using required documents submitted. I understand,
acknowledge and agree that the Lender can share any tax information that I have provided with SBA's authorized representatives,
including authorized representatives of the SBA Office of Inspector General, for the purpose of compliance with SBA Loan
Program Requirements and all SBA reviews.
Eric Ryan Shibley Digitally signed by Eric Ryan Shibley
Date: 2020.04.15 19:08:46 -07'00'
_________________________________________________________ 04/15/2020
________________________
Signature of Authorized Representative of Applicant Date
Eric R Shibley 04/15/2020
Print Name Title
2
SBA Form 2483 (04/20)
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 22 of 34
Paycheck Protection Program
Borrower Application Form
Purpose of this form:
This form is to be completed by the authorized representative of the Applicant and submitted to your SBA Participating Lender. Submission of
the requested information is required to make a determination regarding eligibility for financial assistance. Failure to submit the information
would affect that determination.
Instructions for completing this form:
With respect to “purpose of the loan,” payroll costs consist of compensation to employees (whose principal place of residence is the United
States) in the form of salary, wages, commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tips
or, in the absence of such records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental, family, medical, or
sick leave; allowance for separation or dismissal; payment for the provision of employee benefits consisting of group health care coverage,
including insurance premiums, and retirement; payment of state and local taxes assessed on compensation of employees; and for an
independent contractor or sole proprietor, wage, commissions, income, or net earnings from self-employment or similar compensation.
For purposes of calculating “Average Monthly Payroll,” most Applicants will use the average monthly payroll for 2019, excluding costs over
$100,000 on an annualized basis for each employee. For seasonal businesses, the Applicant may elect to instead use average monthly payroll
for the time period between February 15, 2019 and June 30, 2019, excluding costs over $100,000 on an annualized basis for each employee.
For new businesses, average monthly payroll may be calculated using the time period from January 1, 2020 to February 29, 2020, excluding
costs over $100,000 on an annualized basis for each employee.
If Applicant is refinancing an Economic Injury Disaster Loan (EIDL): Add the outstanding amount of an EIDL made between January 31, 2020
and April 3, 2020, less the amount of any “advance” under an EIDL COVID-19 loan, to Loan Request as indicated on the form.
All parties listed below are considered owners of the Applicant as defined in 13 CFR § 120.10, as well as “principals”:
x For a sole proprietorship, the sole proprietor;
x For a partnership, all general partners, and all limited partners owning 20% or more of the equity of the firm;
x For a corporation, all owners of 20% or more of the corporation;
x For limited liability companies, all members owning 20% or more of the company; and
x Any Trustor (if the Applicant is owned by a trust).
Paperwork Reduction Act – You are not required to respond to this collection of information unless it displays a currently valid OMB
Control Number. The estimated time for completing this application, including gathering data needed, is 8 minutes. Comments about this time
or the information requested should be sent to : Small Business Administration, Director, Records Management Division, 409 3rd St., SW,
Washington DC 20416., and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Washington DC
20503.
Privacy Act (5 U.S.C. 552a) – Under the provisions of the Privacy Act, you are not required to provide your social security number. Failure to
provide your social security number may not affect any right, benefit or privilege to which you are entitled. (But see Debt Collection Notice
regarding taxpayer identification number below.) Disclosures of name and other personal identifiers are required to provide SBA with
sufficient information to make a character determination. When evaluating character, SBA considers the person’s integrity, candor, and
disposition toward criminal actions. Additionally, SBA is specifically authorized to verify your criminal history, or lack thereof, pursuant to
section 7(a)(1)(B), 15 USC Section 636(a)(1)(B) of the Small Business Act (the Act).
Disclosure of Information – Requests for information about another party may be denied unless SBA has the written permission of the
individual to release the information to the requestor or unless the information is subject to disclosure under the Freedom of Information Act.
The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use is the disclosure of
information maintained in SBA’s system of records when this information indicates a violation or potential violation of law, whether civil,
criminal, or administrative in nature. Specifically, SBA may refer the information to the appropriate agency, whether Federal, State, local or
foreign, charged with responsibility for, or otherwise involved in investigation, prosecution, enforcement or prevention of such violations.
Another routine use is disclosure to other Federal agencies conducting background checks but only to the extent the information is relevant to
the requesting agencies' function. See, 74 F.R. 14890 (2009), and as amended from time to time for additional background and other routine
uses. In addition, the CARES Act, requires SBA to register every loan made under the Paycheck Protection Act using the Taxpayer
Identification Number (TIN) assigned to the borrower.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) – SBA must obtain your taxpayer
identification number when you apply for a loan. If you receive a loan, and do not make payments as they come due, SBA may: (1) report the
status of your loan(s) to credit bureaus, (2) hire a collection agency to collect your loan, (3) offset your income tax refund or other amounts
due to you from the Federal Government, (4) suspend or debar you or your company from doing business with the Federal Government, (5)
refer your loan to the Department of Justice, or (6) foreclose on collateral or take other action permitted in the loan instruments.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) – The Right to Financial Privacy Act of 1978, grants SBA access rights to
financial records held by financial institutions that are or have been doing business with you or your business including any financial
3
SBA Form 2483 (04/20)
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 23 of 34
Paycheck Protection Program
Borrower Application Form
institutions participating in a loan or loan guaranty. SBA is only required provide a certificate of its compliance with the Act to a financial
institution in connection with its first request for access to your financial records. SBA's access rights continue for the term of any approved
loan guaranty agreement. SBA is also authorized to transfer to another Government authority any financial records concerning an approved
loan or loan guarantee, as necessary to process, service or foreclose on a loan guaranty or collect on a defaulted loan guaranty.
Freedom of Information Act (5 U.S.C. 552) – Subject to certain exceptions, SBA must supply information reflected in agency files and
records to a person requesting it. Information about approved loans that will be automatically released includes, among other things, statistics
on our loan programs (individual borrowers are not identified in the statistics) and other information such as the names of the borrowers (and
their officers, directors, stockholders or partners), the collateral pledged to secure the loan, the amount of the loan, its purpose in general terms
and the maturity. Proprietary data on a borrower would not routinely be made available to third parties. All requests under this Act are to be
addressed to the nearest SBA office and be identified as a Freedom of Information request.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.) – The Occupational Safety and Health Administration (OSHA) can require
businesses to modify facilities and procedures to protect employees. Businesses that do not comply may be fined, forced to cease operations,
or prevented from starting operations. Signing this form is certification that the applicant, to the best of its knowledge, is in compliance with
the applicable OSHA requirements, and will remain in compliance during the life of the loan.
Civil Rights (13 C.F.R. 112, 113, 117) – All businesses receiving SBA financial assistance must agree not to discriminate in any business
practice, including employment practices and services to the public on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117 of
SBA Regulations. All borrowers must display the "Equal Employment Opportunity Poster" prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691) – Creditors are prohibited from discriminating against credit applicants on the basis of race,
color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into a binding contract); because all
or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right
under the Consumer Credit Protection Act.
Debarment and Suspension Executive Order 12549; (2 CFR Part 180 and Part 2700) – By submitting this loan application, you certify
that neither the Applicant or any owner of the Applicant have within the past three years been: (a) debarred, suspended, declared ineligible or
voluntarily excluded from participation in a transaction by any Federal Agency; (b) formally proposed for debarment, with a final
determination still pending; (c) indicted, convicted, or had a civil judgment rendered against you for any of the offenses listed in the
regulations or (d) delinquent on any amounts owed to the U.S. Government or its instrumentalities as of the date of execution of this
certification.
4
SBA Form 2483 (04/20)
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 24 of 34
DOJ-01-0000001539
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 25 of 34
DOJ-01-0000001540
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 26 of 34
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 27 of 34
Paycheck Protection Program
Borrower Application Form
ae
ho
Py Ava
fou:
Lo
“Niste®
OMB Control No.: 3245-0407
Expiration Date: 09/30/2020
Check One: QO) Sole proprietor O) Partnership OQ C-Corp OS-Corp |LLC
Q) Independent contractor O Eligible self-employed individual
QO) 501(c)(3) nonprofit O 501(c)(19) veterans organization
O) Tribal business (sec. 31(b)(2)(C) of Small Business Act) O1 Other
Business Legal Name
DBA or Tradename if Applicable
ES1 LLC
Business Address Business TIN (EIN, SSN) Business Phone
4700 36th Ave SW MEMMs49 40693842901
Primary Contact Email Address
Eric SHibley ers98126@gmail.com
Average Monthly Payroll:
° 40000 Advance ( i? Applica e)
Equals Loan Request:
$ | 00000 Number of Employees:| 5
Purpose of the loan
(select more than one):
[=]Payroll [Lease /Mortgage Interest [Utilities [JOther (explain): employee benefits
Applicant Ownership
List all owners of 20% or more of the equity of the Applicant. Attach a separate sheet if necessary.
Owner Name
Title
Ownership %
TIN (EIN, SSN)
Address
Eric R Shibley
Manager
100
WN -5 24/4700 36th Ave SW Seattle
Tf questions (1) or (2) below are answered “Yes,” the loan will not be approved.
Question
| Yes | No |
1. Is the Applicant or any owner of the Applicant presently suspended, debarred, proposed for debarment, declared ineligible,
voluntarily excluded from participation in this transaction by any Federal department or agency, or presently involved in any TC [m]
bankruptcy?
2. Has the Applicant, any owner of the Applicant, or any business owned or controlled by any of them, ever obtained a direct or L] =
guaranteed loan from SBA or any other Federal agency thatis currently delinquent or has defaulted in the last 7 years and
caused a loss to the government?
3. Is the Applicant or any owner of the Applicant an owner of any other business, or have common management with, any other
f® oO
business? If yes, list all such businesses and describe the relationship on a separate sheet identified as addendum A.
4. Has the Applicant received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020? | f yes, O
provide details on a separate sheet identified as addendum B.
Tf questions (5) or (6) are answered “‘Yes,”’ the loan will not be approved.
Question
| Yes | No |
5. — Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject ol
to an indictment, criminal information, arraignment, or other means by which formal criminal charges are O
brought in any jurisdiction, or presently incarcerated, or on probation or parole?
Initial here to confirm your response to question 5 —
ers
6. Within the last 5 years, for any felony, has the Applicant (if an individual) or any owner of the Applicant 1)
been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been C] [|
placed on any form of parole or probation (including probation before judgment)?
Initial here to confirm your response to question6— €&s
7. |s the United States the principal place of residence for all employees of the Applicant included in the [a]
Applicant’s payroll calculation above?
8. — Isthe Applicant a franchise that is listed in the SBA’s Franchise Directory?
SBA Form 2483 (04/20)
U.S. v. Shibley CO
CR20-174
JCC
Government Exhibit No. 16
Admitted
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 28 of 34
Paycheck Protection Program
Borrower Application Form
By Signing Below, You Make the Following Representations, Authorizations, and Certifications
CERTIFICATIONS AND AUTHORIZATIONS
I certify that:
x I have read the statements included in this form, including the Statements Required by Law and Executive Orders, and I understand them.
x The Applicant is eligible to receive a loan under the rules in effect at the time this application is submitted that have been issued by the
Small Business Administration (SBA) implementing the Paycheck Protection Program under Division A, Title I of the Coronavirus
Aid, Relief, and Economic Security Act (CARES Act) (the Paycheck Protection Program Rule).
x The Applicant (1) is an independent contractor, eligible self-employed individual, or sole proprietor or (2) employs no more
than the greater of 500 or employees or, if applicable, the size standard in number of employees established by the SBA in 13
C.F.R. 121.201 for the Applicant’s industry.
x I will comply, whenever applicable, with the civil rights and other limitations in this form.
x All SBA loan proceeds will be used only for business-related purposes as specified in the loan application and consistent with the
Paycheck Protection Program Rule.
x To the extent feasible, I will purchase only American-made equipment and products.
x The Applicant is not engaged in any activity that is illegal under federal, state or local law.
x Any loan received by the Applicant under Section 7(b)(2) of the Small Business Act between January 31, 2020 and April 3, 2020 was
for a purpose other than paying payroll costs and other allowable uses loans under the Paycheck Protection Program Rule.
For Applicants who are individuals: I authorize the SBA to request criminal record information about me from criminal justice agencies for the
purpose of determining my eligibility for programs authorized by the Small Business Act, as amended.
CERTIFICATIONS
The authorized representative of the Applicant must certify in good faith to all of the below by initialing next to each one:
ers
_____ The Applicant was in operation on February 15, 2020 and had employees for whom it paid salaries and payroll taxes or paid independent
contractors, as reported on Form(s) 1099-MISC.
ers
_____ Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.
ers
_____ The funds will be used to retain workers and maintain payroll or make mortgage interest payments, lease payments, and utility payments,
as specified under the Paycheck Protection Program Rule; I understand that if the funds are knowingly used for unauthorized purposes,
the federal government may hold me legally liable, such as for charges of fraud.
ers
_____ The Applicant will provide to the Lender documentation verifying the number of full-time equivalent employees on the Applicant’s
payroll as well as the dollar amounts of payroll costs, covered mortgage interest payments, covered rent payments, and covered utilities
for the eight-week period following this loan.
ers
_____ I understand that loan forgiveness will be provided for the sum of documented payroll costs, covered mortgage interest payments,
covered rent payments, and covered utilities, and not more than 25% of the forgiven amount may be for non-payroll costs.
ers
_____ During the period beginning on February 15, 2020 and ending on December 31, 2020, the Applicant has not and will not receive another
loan under the Paycheck Protection Program.
ers
_____ I further certify that the information provided in this application and the information provided in all supporting documents and
forms is true and accurate in all material respects. I understand that knowingly making a false statement to obtain a guaranteed loan
from SBA is punishable under the law, including under 18 USC 1001 and 3571 by imprisonment of not more than five years and/or a
fine of up to $250,000; under 15 USC 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if
submitted to a federally insured institution, under 18 USC 1014 by imprisonment of not more than thirty years and/or a fine of not
more than $1,000,000.
ers
_____ I acknowledge that the lender will confirm the eligible loan amount using required documents submitted. I understand,
acknowledge and agree that the Lender can share any tax information that I have provided with SBA's authorized representatives,
including authorized representatives of the SBA Office of Inspector General, for the purpose of compliance with SBA Loan
Program Requirements and all SBA reviews.
Eric Ryan Shibley Digitally signed by Eric Ryan Shibley
Date: 2020.04.15 19:08:46 -07'00'
_________________________________________________________ 04/15/2020
________________________
Signature of Authorized Representative of Applicant Date
Eric R Shibley 04/15/2020
Print Name Title
2
SBA Form 2483 (04/20)
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 29 of 34
Paycheck Protection Program
Borrower Application Form
Purpose of this form:
This form is to be completed by the authorized representative of the Applicant and submitted to your SBA Participating Lender. Submission of
the requested information is required to make a determination regarding eligibility for financial assistance. Failure to submit the information
would affect that determination.
Instructions for completing this form:
With respect to “purpose of the loan,” payroll costs consist of compensation to employees (whose principal place of residence is the United
States) in the form of salary, wages, commissions, or similar compensation; cash tips or the equivalent (based on employer records of past tips
or, in the absence of such records, a reasonable, good-faith employer estimate of such tips); payment for vacation, parental, family, medical, or
sick leave; allowance for separation or dismissal; payment for the provision of employee benefits consisting of group health care coverage,
including insurance premiums, and retirement; payment of state and local taxes assessed on compensation of employees; and for an
independent contractor or sole proprietor, wage, commissions, income, or net earnings from self-employment or similar compensation.
For purposes of calculating “Average Monthly Payroll,” most Applicants will use the average monthly payroll for 2019, excluding costs over
$100,000 on an annualized basis for each employee. For seasonal businesses, the Applicant may elect to instead use average monthly payroll
for the time period between February 15, 2019 and June 30, 2019, excluding costs over $100,000 on an annualized basis for each employee.
For new businesses, average monthly payroll may be calculated using the time period from January 1, 2020 to February 29, 2020, excluding
costs over $100,000 on an annualized basis for each employee.
If Applicant is refinancing an Economic Injury Disaster Loan (EIDL): Add the outstanding amount of an EIDL made between January 31, 2020
and April 3, 2020, less the amount of any “advance” under an EIDL COVID-19 loan, to Loan Request as indicated on the form.
All parties listed below are considered owners of the Applicant as defined in 13 CFR § 120.10, as well as “principals”:
x For a sole proprietorship, the sole proprietor;
x For a partnership, all general partners, and all limited partners owning 20% or more of the equity of the firm;
x For a corporation, all owners of 20% or more of the corporation;
x For limited liability companies, all members owning 20% or more of the company; and
x Any Trustor (if the Applicant is owned by a trust).
Paperwork Reduction Act – You are not required to respond to this collection of information unless it displays a currently valid OMB
Control Number. The estimated time for completing this application, including gathering data needed, is 8 minutes. Comments about this time
or the information requested should be sent to : Small Business Administration, Director, Records Management Division, 409 3rd St., SW,
Washington DC 20416., and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Washington DC
20503.
Privacy Act (5 U.S.C. 552a) – Under the provisions of the Privacy Act, you are not required to provide your social security number. Failure to
provide your social security number may not affect any right, benefit or privilege to which you are entitled. (But see Debt Collection Notice
regarding taxpayer identification number below.) Disclosures of name and other personal identifiers are required to provide SBA with
sufficient information to make a character determination. When evaluating character, SBA considers the person’s integrity, candor, and
disposition toward criminal actions. Additionally, SBA is specifically authorized to verify your criminal history, or lack thereof, pursuant to
section 7(a)(1)(B), 15 USC Section 636(a)(1)(B) of the Small Business Act (the Act).
Disclosure of Information – Requests for information about another party may be denied unless SBA has the written permission of the
individual to release the information to the requestor or unless the information is subject to disclosure under the Freedom of Information Act.
The Privacy Act authorizes SBA to make certain “routine uses” of information protected by that Act. One such routine use is the disclosure of
information maintained in SBA’s system of records when this information indicates a violation or potential violation of law, whether civil,
criminal, or administrative in nature. Specifically, SBA may refer the information to the appropriate agency, whether Federal, State, local or
foreign, charged with responsibility for, or otherwise involved in investigation, prosecution, enforcement or prevention of such violations.
Another routine use is disclosure to other Federal agencies conducting background checks but only to the extent the information is relevant to
the requesting agencies' function. See, 74 F.R. 14890 (2009), and as amended from time to time for additional background and other routine
uses. In addition, the CARES Act, requires SBA to register every loan made under the Paycheck Protection Act using the Taxpayer
Identification Number (TIN) assigned to the borrower.
Debt Collection Act of 1982, Deficit Reduction Act of 1984 (31 U.S.C. 3701 et seq. and other titles) – SBA must obtain your taxpayer
identification number when you apply for a loan. If you receive a loan, and do not make payments as they come due, SBA may: (1) report the
status of your loan(s) to credit bureaus, (2) hire a collection agency to collect your loan, (3) offset your income tax refund or other amounts
due to you from the Federal Government, (4) suspend or debar you or your company from doing business with the Federal Government, (5)
refer your loan to the Department of Justice, or (6) foreclose on collateral or take other action permitted in the loan instruments.
Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) – The Right to Financial Privacy Act of 1978, grants SBA access rights to
financial records held by financial institutions that are or have been doing business with you or your business including any financial
3
SBA Form 2483 (04/20)
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 30 of 34
Paycheck Protection Program
Borrower Application Form
institutions participating in a loan or loan guaranty. SBA is only required provide a certificate of its compliance with the Act to a financial
institution in connection with its first request for access to your financial records. SBA's access rights continue for the term of any approved
loan guaranty agreement. SBA is also authorized to transfer to another Government authority any financial records concerning an approved
loan or loan guarantee, as necessary to process, service or foreclose on a loan guaranty or collect on a defaulted loan guaranty.
Freedom of Information Act (5 U.S.C. 552) – Subject to certain exceptions, SBA must supply information reflected in agency files and
records to a person requesting it. Information about approved loans that will be automatically released includes, among other things, statistics
on our loan programs (individual borrowers are not identified in the statistics) and other information such as the names of the borrowers (and
their officers, directors, stockholders or partners), the collateral pledged to secure the loan, the amount of the loan, its purpose in general terms
and the maturity. Proprietary data on a borrower would not routinely be made available to third parties. All requests under this Act are to be
addressed to the nearest SBA office and be identified as a Freedom of Information request.
Occupational Safety and Health Act (15 U.S.C. 651 et seq.) – The Occupational Safety and Health Administration (OSHA) can require
businesses to modify facilities and procedures to protect employees. Businesses that do not comply may be fined, forced to cease operations,
or prevented from starting operations. Signing this form is certification that the applicant, to the best of its knowledge, is in compliance with
the applicable OSHA requirements, and will remain in compliance during the life of the loan.
Civil Rights (13 C.F.R. 112, 113, 117) – All businesses receiving SBA financial assistance must agree not to discriminate in any business
practice, including employment practices and services to the public on the basis of categories cited in 13 C.F.R., Parts 112, 113, and 117 of
SBA Regulations. All borrowers must display the "Equal Employment Opportunity Poster" prescribed by SBA.
Equal Credit Opportunity Act (15 U.S.C. 1691) – Creditors are prohibited from discriminating against credit applicants on the basis of race,
color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into a binding contract); because all
or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right
under the Consumer Credit Protection Act.
Debarment and Suspension Executive Order 12549; (2 CFR Part 180 and Part 2700) – By submitting this loan application, you certify
that neither the Applicant or any owner of the Applicant have within the past three years been: (a) debarred, suspended, declared ineligible or
voluntarily excluded from participation in a transaction by any Federal Agency; (b) formally proposed for debarment, with a final
determination still pending; (c) indicted, convicted, or had a civil judgment rendered against you for any of the offenses listed in the
regulations or (d) delinquent on any amounts owed to the U.S. Government or its instrumentalities as of the date of execution of this
certification.
4
SBA Form 2483 (04/20)
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 31 of 34
DOJ-01-0000001547
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 32 of 34
DOJ-01-0000001548
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 33 of 34
DOJ-01-0000001558
Case 2:20-cr-00174-JCC Document 137-5 Filed 11/26/21 Page 34 of 34
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