Court filing
Trial Exhibit (GX 225): Stipulation of Facts — U.S. v. Shibley
Filed November 26, 2021 in U.S. v. Shibley; one of 10 filings from this case.
Record facts
| Court | U.S. District Court for the Western District of Washington (Seattle) |
|---|---|
| Filed | 2021-11-26 |
U.S. District Court for the Western District of Washington (Seattle) · No. 2:20-cr-00174-JCC · Doc. 137-13 · 2021-11-26 · Docket on CourtListener
Full text
U.S. v. Shibley
CR20-174 JCC
Government Exhibit No. 211
Admitted _____________
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 1 of 282
DOJ-10-0000025209
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 2 of 282
DOJ-10-0000025207
U.S. v. Shibley
CR20-174 JCC
Government Exhibit No. 212
Admitted _____________
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 3 of 282
DOJ-10-0000025214
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 4 of 282
DOJ-10-0000025212
U.S. v. Shibley
CR20-174 JCC
Government Exhibit No. 213
Admitted _____________
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 5 of 282
DOJ-10-0000025219
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 6 of 282
DOJ-10-0000025217
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The Honorable John C. Coughenour
LINITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF WASHINGTON
AT SEATTLE
UNITED STATES OF AMERICA.
Plaintiff,
NO. CR2O-I74JCC
STIPULATION
v.
ERIC SHIBLEY,
Defendant.
The United States ofAmerica and the Defendant. Eric Shibley, hereby stipulate
and agree to the following facts.
1.
On June 10,,2020, Defendant Eric Shibley was served with subpoenas for
documents from a federal grand jury sitting in the District of Columbia.
The subpoenas requested documents related to the business operations of
ES I LLC, SS 1 LLC, The A Team Holdings [,LC, Dituri Construction LLC
and Eric R Shibley MD PLLC.
2.
Working through his attorney, Eric Shibley provided the following
documents in response to the subpoena via email:
a. Certificates of Formation for ES 1 LLC, SS I LLC, The A Team
Holdings LLC, and Eric R Shibley MD PLLC;
STIPULATION - I
U.S. v. Eric Shibley, CR20-174JCC
UNITUD ST TES AITORNEY
700 Sr LwARr SrREE r. STr 5220
SriAT'r'LE. WASHINGToN 98 I 0 I
(206) ss3-7970
U.S. v. Shibley
CR20-174 JCC
Government Exhibit No. 225
Admitted ________________
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 7 of 282
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b. Operating Agreements for ES I LLC, SS I LLC, The A Team Holdings
LLC, Dituri Construction LLC and Eric R Shibley MD PLLC;
c. A Purchase Agreement for Dituri Construction LLC, dated May 9, 2020;
d. Internal Revenue Service Form W-3 (Transmittal of Wage and Tax
Statements) for SS I LLC dated April 22.2020;
e. Internal Revenue Service Form W-3 (Transmittal of Wage and Tax
Statements) for ES I LLC dated April 22,2020; and
f. Internal Revenue Service Form W-3 (Transmittal of Wage and Tax
Statements) for Eric R. Shibley MD PLI,C dated April 24,2020.
g. SSl LLC Form 941 Employer's Quarterly Federal Tax Return (4ttt
Quarter 2019);
h. A Team Holding, LLC Fonn 941 Employer's Quarterly Federal Tax
Return ({ttt Quarter 2019):
i. SSI LLC Form 941 Employer's Quarterly Federal Tax Return ( I't
Quarter 2020);
j. A Tearn Holding. LLC Form 941 Employer's Quarterly Federal Tax
Return (l$ Quarter 2020);
k. Dituri Constructionl LLC F'orm 941 Employer's Quarterly Federal Tax
Return (lst Quarter 2020):
l. SFC LLC Form 941 Employer's Quarterly FederalTax Return (1't
Quarter 2020);
m. Eric Shibley MD, PLLC Forrn 941 Employer's Quarterly Federal 'Iax
Return (1st Quarter 2020):
n. ESl LLC Form 941 Employer's Quarterly Federal Tax Return (lst
Quarrer 2020):
STIPULATION - 2
U.S. v. Eric Shibley. CP20-l74JCC
IJNII HD STAII]S ATTORNEY
700 S'rr-w,rnr STRLTET. SrE 5220
SuArrLE. WASIilNG ToN 98 I 0l
(206) 553-7970
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 8 of 282
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o. Certificate of Existence for SFC LI-C;
p. Business Information for SFC LLC1,
q. Operating Agreement for SFC LLC;
r. IRS Form W-3 form (Transmittal of Wage and Tax Statement) fbr SFC
LLC, dated April 24,2020;
s. Photograph of Washington State Driver License of Eric Shibley;
t. PPP Borrower Application Form fbr Dituri Construction [.LC. dated
June 4, 2020:
u. PPP Borrower Application Form for ES 1 Lt.C, dated April 15, 2020;
v. PPP Borrower Application Form fbr The A Team Holding LLC. dated
April 15,2020;
w. PPP Borrower Application Fonn for SS I LLC, dated April 20,2020,:
x. PPP Borrower Application Fonn for Eric Shibley MD PLLC. dated
April 24,2020;
y. PPP Borrower Application Form lbr SFC LLC, dated April 25,2020;
z. Wells Fargo bank statements for Eric Shibley MD PLLC. acct
#3220067247;
aa. Wells Fargo bank statements for ES1 LLC, acct#7621559124;
bb. Wells Fargo bank statements for ES1 LLC, acct#3365602378:
cc. Wells Fargo bank statements for Eric Shibley MD PI-LC. acct
#6621617262;
dd. Redacted email string re: SS I LLC loan application: and
ee. Eric Shibley email to Mario Davis, dated June 25, 2020.
3.
Eric Shibley produced no other documents in response to the subpoenas.
STIPULATION - 3
U.S. v. Eric Shibley. CP.20-l74lCC
TJNITED S IATES AI IORNI]Y
700 Srerv,rn'r Srner:r'. SrFr 5220
Sr, lrrr.r,. W.\sH rN(iro\ 9ll | 0 I
(206) ss3-7970
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 9 of 282
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4.
The production of these documents occurred in the Western District of
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Washington when they were sent via email.
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5.
All of the documents listed in Paragra ph2 areattached to this stipulation.
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DArED this It day of {anu ,2021.
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By:
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Laura Connelly
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Brian Werner
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u.S. Department of Justice
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By;
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Michadl C. Nance, WSBA #13933
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4.
The production of these documents occurred in the Western District of
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Washington when they were sent via email.
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5.
All of the documents listed in Paragra ph2 areattached to this stipulatir
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DArED this It oay or {anu ,2021.
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u.S. Department of rustice
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Attorney for Defendant Eric Shibley
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llus. v. Eric Shibtey,CR2o- t74lCC
LIN ITED S]'AI-ES ATTORNEY
700 Srrwrrnr Srnur:r. Srp 5220
Sr,Arrr-[. WASHTNcToN 98 I 0 I
(206) 553-7970
B
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 10 of 282
U.S. v. Shibley
CR20-174 JCC
Government Exhibit No. 225
Admitted _____________
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Operating Agreement
Dituri Construction LLC,
a Washington Limited Liability Company
THISOPERATING AGREEMENT Dituri Construction LLC of (the "Company")
is entered into as of the date set forth on the signature page of this Agreement by each of the
Members listed on Exhibit A of this Agreement.
A.
The Members have formed the Company as a Washington limited liability
company under the Washington Limited Liability Company Act. The purpose of the
Company is to conduct any lawful business for which limited liability companies may be
organized under the laws of the state of Washington. The Members hereby adopt and
approve the certificate of formation of the Company filed with the Washington Secretary
of State.
B.
The Members enter into this Agreement to provide for the governance of
the Company and the conduct of its business, and to specify their relative rights and
obligations.
ARTICLE 1: DEFINITIONS
Capitalized terms used in this Agreement have the meanings specified in this
Article1 or elsewhere in this Agreement and if not so specified, have the meanings set forth
in the Washington Limited Liability Company Act.
"Agreement" means this Operating Agreement of the Company, as may be
amended from time to time.
"Capital Account" means, with respect to any Member, an account consisting of
such Member's Capital Contribution, (1) increased by such Member's allocated share of
income and gain, (2) decreased by such Member's share of losses and deductions,
(3) decreased by any distributions made by the Company to such Member, and
(4) otherwise adjusted as required in accordance with applicable tax laws.
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 44 of 282
"Capital Contribution" means, with respect to any Member, the total value of
(1) cash and the fair market value of property other than cash and (2) services that are
contributed and/or agreed to be contributed to the Company by such Member, as listed on
Exhibit A, as may be updated from time to time according to the terms of this agreement.
" Exhibit" means a document attached to this Agreement labeled as "Exhibit A,"
"Exhibit B," and so forth, as such document may be amended, updated, or replaced from
time to time according to the terms of this Agreement.
''Manager" means each Person who has authority to manage the business and
affairs of the Company pursuant to this Agreement; such Persons are listed on Exhibit
B, as may be updated from time to time according to the terms of this Agreement. A
Manager may be, but is not required to be, a Member.
"Member" means each Person who acquires Membership Interest pursuant to this
Agreement. The Members are listed on Exhibit A, as may be updated from time to time
according to the terms of this Agreement. Each Member has the rights and obligations
specified i..n this Agreement.
"Membership Interest" means the entire ownership interest of a Member in the
Company at any particular time, including the right to any and all benefits to which a
Member may be en1titled as provided in this agreement and under the Washington Limited
Liability Company Act, together with the obligations of the Member to comply with all of
the terms and provisions of this Agreement.
"Ownership Interest" means the Percentage Interest or Units, as applicable,
based on the manner in which relative ownership of the Company is divided.
"Percentage Interest" means the percentage of ownership in the Company that,
with respect to each Member, entitles the Member to a Membership Interest and is
expressed as either:
A.
If ownership in the Company is expressed in terms of percentage, the
percentage set forth opposite the name of each Member on Exhibit A, as may be
adjusted from time to time pursuant to this Agreement; or
-2-
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 45 of 282
B.
If ownership in the Company is expressed in Units, the ratio, expressed as
a percentage, of:
(1)
the number of Units owned by the Member (expressed as "MU" in
the equation below) divided by
(2)
the total number of Units owned by all of the Members of the
Company (expressed as "TU" in the equation below).
Percentage Interest= -MU-
TU
"Person" means an individual (natural person), partnership, limited partnership,
trust, estate, association, corporation, limited liability company, or other entity, whether
domestic or foreign.
"Units" mean, if ownership in the Company is expressed in Units, units of
ownership in the Company, that, with respect to each Member, entitles the Member to
a Membership Interest which, if applicable, is expressed as the number of Units set
forth opposite the name of each Member on Exhibit A, as may be adjusted from time
to time pursuant to this Agreement.
ARTICLE 2: CAPITAL CONTRIBUTIONS, ADDITIONAL
MEMBERS, CAPITAL ACCOUNTS AND LIMITED LIABILITY
2.1 Initial Capital Contributions . The names of all Members and each of their
respective addresses, initial Capital Contributions, and Ownership Interests must be set
forth on Exhibit A. Each Member has made or agrees to make the initial Capital
Contribution set forth next to such Membe1's name on Exhibit A to become a Member
of the Company.
2.2 Subsequent Capital Contributions. Members are not obligated to make
additional Capital Contributions unless unanimously agreed by all the Members. If
subsequent Capital Contributions are unanimously agreed by all the Members in a
consent in writing, the Members may make such additional Capital Contributions on a
pro rata basis in accordance with each Member's respective Percentage Interest or as
otherwise unanimously agreed by the Members.
-3-
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 46 of 282
2.3 Additional Members.
A.
With the exception of a transfer of interest (1) governed by Article 7 of this
Agreement or (2) otherwise expressly authorized by this Agreement, additional Persons
may become Members of the Company and be issued additional Ownership Interests
only if approved by and on terms determined by a unanimous written agreement
signed by all of th e existing Members.
B.
Before a Person may be admitted as a Member of the Company, that
Person must sign and deliver to the Company the documents and instrun1ents, in the
form and containing the information required by the Company, that the Managers
deem necessary or desirable. Membership Interests of new Members will be allocated
according to the terms of this Agreement.
2.4 Capital Accounts. Individual Capital Accounts must be maintained for each
Member, unless (a) there is only one Member of the Company and (b) the Company is
exempt according to applicable tax laws. Capital Accounts must be maintained in
accordance with all applicable tax laws.
2.5 Interest. No interest will be paid by the Company or otherwise on Capital
Contributions or on the balance of a Member's Capital Account.
2.6 Limited Liability; No Authority. A Member will not be bound by, or be
personally liable for, the expenses, liabilities, debts, contracts, or obligations of the
Company, except as otherwise provided in this Agreement or as required by the
Washington Limited Liability Company Act. Unless expressly provided in this
Agreement, no Member, acting alone, has any authority to undertake or assume any
obligation, debt, or responsibility, or otherwise act on behalf of, the Company or any
other Member.
ARTICLE 3: ALLOCATIONS AND DISTRIBUTIONS
3.1 Allocations. Unless otherwise agreed to by the unanimous consent of the
Members any income, gain, loss, deduction, or credit of the Company will be allocated
for accounting and tax purposes on a pro rata basis in proportion to the respective
Percentage Interest held by each Member and in compliance with applicable tax laws.
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Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 47 of 282
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3.2 Distributions. The Company will have the right to make distributions of cash
and property to the Members on a pro rata basis in proportion to the respective
Percentage Interest held by each Member. The timing and amount of distributions will be
determined by the Managers in accordance with the Washington Limited Liability
Company Act.
3.3 Limitations on Distributions. The Company must not make a distribution to
a Member if, after giving effect to the distribution:
A.
The Company would be unable to pay its debts as they become due in the
usual course of business; or
B.
The fair value of the Company's total assets would be less than the sum of its
total liabilities plus the amount that would be needed, if the Company were to be
dissolved at the time of the distribution, to satisfy the preferential rights upon dissolution
of Members, if any, whose preferential rights are superior to those of the Members
receiving the distribution.
ARTICLE 4: MANAGEMENT
4.1 Management.
A.
Generally. Subject to the terms of this Agreement and the Washington
Limited Liability Company Act, the business and affairs of the Company will be
managed by the Board of Managers, as further described below. The Members initially
nominate and elect the Person(s) set forth on Exhibit B to serve as the Manager(s) of the
Company. The Managers will act under the direction of the Members and may be elected
or removed at any time, for any reason or no reason, by the Members holding a majority of
the Voting Interest of the Company. Exhibit B must be amended to reflect any changes in
Managers.
B.
Approval and Action. Unless greater or other authorization is required
pursuant to this Agreement or under the Washington Limited Liability Company Act for
the Company to engage in an activity or transaction, all activities or transactions must be
approved by a majority of Managers, to constitute the act of the Company or serve to bind
the Company, but if the Managers cannot reach a majority vote, the dispute will be
submitted to the Members to be resolved by the affirmative vote of the Members holding
at least a majority of the Voting Interest of the Company. With such approval, the
signature of any Managers authorized to sign on behalf of the Company is sufficient to
bind the Company with respect to the matter or matters so approved.
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Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 48 of 282
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without such approval, no Managers acting alone may bind the Company to any
agreement with or obligation to any third party or represent or claim to have the ability
to so bind the Company.
C.
Certain Decisions Requiring Greater Authorization. Notwithstanding
clause B above, the following matters require unanimous approval of the Members in a
consent in writing to constitute an act of the Company:
(i)
A material change in the purposes or the nature of the Company's
business;
(ii)
With the exception of a transfer of interest governed by Article 7 of
this Agreement, the admission of a new Member or a change in any
Member's Membership Interest, Ownership Interest, Percentage
Interest, or Voting Interest in any manner other than in accordance
with this Agreement;
(iii)
The merger of the Company with any other entity or the sale of all
or substantially all of the Company's assets; and
(iv)
The amendment of this Agreement.
4.2 Meetings of Managers. Regular meetings of the Managers are not required
but may be held at such time and place as the Managers deem necessary or desirable
for the reasonable management of the Company. Meetings may take place in person,
by conference call, or by any other means permitted under the Washington Limited
Liability Company Act. In addition, Company actions requiring a vote may be carried
out without a meeting if all of the Managers consent in writing to approve the action.
4.3 Officers. The Managers are authorized to appoint one or more officers from
time to time. The officers will have the titles, the authority, exercise the powers, and
perform the duties that the Managers determine from time to time. Each officer will
continue to perform and hold office until such time as (a) the officer's successor is
chosen and appointed by the Managers; or (b) the officer is dismissed or terminated by
the Managers, which termination will be subject to applicable law and, if an effective
employment agreement exists between the officer and the Company, the employment
agreement. Subject to applicable law and the employment agreement (if any), each
officer will serve at the direction of Managers, and may be terminated, at any time and
for any reason, by the Managers.
-6-
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 49 of 282
ARTICLE 5: ACCOUNTS AND ACCOUNTING
5.1 Accounts. The Company must maintain complete accounting records of the
Company's business, including a full and accurate record of each Company transaction.
The records must be kept at the Company's principal executive office and must be
open to inspection and copying by Members during normal business hours upon
reasonable notice by the Members wishing to inspect or copy the records or their
authorized representatives, for purposes reasonably related to the Membership
Interest of such Members. The costs of inspection and copying will be borne by the
respective Member.
5.2 Records . The Managers will keep or cause the Company to keep the
following business records.
(i}
An up to date list of the Members, each of their respective full legal
names, last known business or residence address, Capital
Contributions, the amount and terms of any agreed upon future
Capital Contributions, and Ownership Interests, and Voting
Interests;
(ii)
A copy of the Company's federal, state, and local tax information
and income tax returns and reports, if any, for the six most recent
taxable years;
(iii} A copy of the certificate of formation of the Company, as may be
amended from time to time ("Certificate of Formation"); and
(iv)
An original signed copy, which may include counterpart
signatures, of this Agreement, and any amendments to this
Agreement, signed by all then-current Members.
5.3 Income Tax Returns. Within 45 days after the end of each taxable year, the
Company will use its best efforts to send each of the Members all information necessary
for the Members to complete their federal and state tax information, returns, and
copy of the Company's federal, state, and local tax information or income tax return
and reports for such year.
5.4 Subchapter S Election. The Company may, upon unanimous consent of the
Members, elect to be treated for income tax purposes as an S Corporation. This
designation may be changed as permitted under the Internal Revenue Code
Section 1362(d) and applicable Regulations.
-7-
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 50 of 282
5.5 Tax Matters Member. Anytime the Company is required to designate or select
a tax matters partner pursuant to Section 6231(a)(7) of the Internal Revenue Code and any
regulations issued by the Internal Revenue Service, the Members must designate one of the
Members as the tax matters partner of the Company and keep such designation in effect at
all times.
5.6 Banking. All funds of the Company must be deposited in one or more bank
accounts in the name of the Company with one or more recognized financial institutions.
The Managers are authorized to establish such accounts and complete, sign, and de live r
any banking resolutions reasonably required by the respective financial institutions in
order to establish an account.
ARTICLE 6: MEMBERSHIP - VOTING AND MEETINGS
6.1 Members and Voting Rights. The Members have the right and power to vote
on all matters with respect to which the Certificate of Formation, this Agreement, or the
Washington Limited Liability Company Act requires or permits. Unless otherwise stated
in this Agreement (for example, in Section 4.l (c))or required under the Washing ton
Limited Liability Company Act, the vote of the Members holding at least a majority of the
Voting Interest of the Company is required to approve or carry out an action.
6.2 Meetings of Members. Annual, regular, or special meetings of the Members are
not required but may be held at such time and place as the Members deem necessary
or desirable for the reasonable management of the Company. A written notice setting forth
the date, time, and location of a meeting must be sent within a reasonable period of time
before the date of the meeting to each Member entitled to vote at the meeting. A
Member may waive notice of a meeting by sending a signed waiver to the Company's
principal executive office or as otherwise provided in the Washington Limited
Liability Company Act. In any instance in which the approval of the Members is required
under this Agreement, such approval may be obtained in any manner permitted by the
Washington Limited Liability Company Act, including by conference call or similar
communications equipmen t. Any action that could be taken at a meeting may be approved
by a consent in writing that describes the action to be taken and is signed by Members
holding the minimum Voting Interest required to approve the action. If any action is
taken without a meeting and without unanimous written consent of the Members, notice of
such action must be sent to each Member that did not consent
to the action.
-8-
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 51 of 282
ARTICLE 7: WITHDRAWAL AND TRANSFERS OF MEMBERSHIP INTERESTS
7.1
Withdrawal. Members may withdraw from the Company prior to the
dissolution and winding up of the Company (a) by transferring or assigning all of their
respective Membership Interests pursuant to Section 7.2 below, or (b) if all of the
Members unanimously agree in a written consent. Subject to the provisions of Article 3,
a Member that withdraws pursuant to this Section 7.1 will be entitled to a distribution
from the Company in an amoU11t equal to such Member's Capital Account.
7.2 Restrictions on Transfer; Admission of Transferee. A Member may transfer
Membership Interests to any other Person without the consent of any other Member. A
person may acquire Membership Interests directly from the Company upon the written
consent of all Members. A Person that acquires Membership Interests in accordance
with this Section 7.2 will be admitted as a Member of the Company only after the
requirements of Section 2.3(b) are complied with in full.
ARTICLE 8: DISSOLUTION
8.1 D issolution . The Company will be dissolved upon the first to occur of the
following events:
(i)
The unanimous agreement of all Members in a consent in writing
to dissolve the Company;
(ii)
Entry of a decree of judicial dissolution under Washington Limited
Liability Company Act;
(iii)
At any time that there are no Members, unless and provided that
the Company is not otherwise required to be dissolved and wound
up, within 90 days after the occurrence of the event that terminated
the continued membership of the last remaining Member, the legal
representative of the last remaining Member agrees in writing to
continue the Company and (i) to become a Member; or (ii) to the
extent that the last remaining Member assigned its interest in the
Company, to cause the Member's assignee to become a Member of
the Company, effective as of the occurrence of the event that
terminated the continued membership of the last remaining
Member;
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"
Company Agent seeking indemnification) or a majority of the Managers that are not
seeking indemnification, as the case may be. Before the Company makes any such
payment of Expenses, the Company Agent seeking indemnification must deliver a
written undertaking to the Company stating that such Company Agent will repay the
applicable Expenses to the Company unless it is ultimately determined that the
Company Agent is entitled or required to be indemnified and held harmless by the
Company (as set forth in Sections 9.1or 9.2 above or as otherwise required by
applicable law).
ARTICLE 10: GENERAL PROVISIONS
10.1 Notice. (a)-Any notices (including requests, demands, or other communications
) to be sent by one party to another party in connection with this Agreement must be in
writing and delivered personally, by reputable overnight courier, or by certified mail (or
equivalent service offered by the postal service from time to time) to the following
addresses or as otherwise notified in accordance with this Section: (i) if to the Company,
notices must be sent to the Company's principal executive office; and (ii) if to a Member,
notices must be sent to the Member's last known address for notice on record. (b) Any
party to this Agreement may change its notice address by sending written notice of such
change to the Company in the manner specified above. Notice will be deemed to have
been duly given as follows: (i) upon delivery, if delivered personally or by reputable
overnight carrier or (ii) five days after the date of posting if sent by certified mail.
10.2 Entire Agreement; Amendment. This Agreement along with the Certificate of
Formation (together, the "Organizational Documents"), constitute the entire agreement
among the Members and replace and supersede all prior written and oral understandings
and agreements with respect to the subject matter of this Agreement, except as otherwise
required by the Washington Limited Liability Company Act. There are no
representations, agreements, arrangements, or undertakings, oral or written, between or
among the Members relating to the subject matter of this Agreement that are not fully
expressed in the Organizational Documents. This Agreement may not be modified or
amended in any respect, except in a writing signed by all of the Members except as
otherwise required or permitted by the Washington Limited Liability Company Act.
10.3 Governing Law; Severability. This Agreement will be construed and enforced
in accordance with the laws of the state of Washington. If any provision of this Agreement
is held to be unenforceable by a court of competent jurisdiction for any reason
whatsoever, (i) the validity, legality, and enforceability of the remaining
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provisions of this Agreement (including without limitation, all portions of any
provisions containing any such unenforceable provision that are not themselves
unenforceable) will not in any way be affected or impaired thereby, and (ii) to the
fullest extent possible, the unenforceable provision will be deemed modified and
replaced by a provision that approximates the intent and economic effect of the
unenforceable provision and the Agreement will be deemed amended accordingly.
10.4 Further Action. Each Member agrees to perform all further acts and execute,
acknowledge, and deliver any documents which may be reasonably necessary,
appropriate, or desirable to carry out the provisions of this Agreement.
10.5 No Third Party Beneficiary. This Agreement is made solely for the benefit of
the parties to this Agreement and their respective permitted successors and assigns, and no
other Person or entity will have or acquire any right by virtue of this Agreement. This
Agreement will be binding on and inure to the benefit of the parties and their heirs,
personal representatives, and permitted successors and assigns.
10.6 Incorporation by Reference. The recitals and each appendix, exhibit,
schedule, and other document attached to or referred to in this Agreement are hereby
incorporated into this Agreement by reference.
10.7 Counterparts. This Agreement may be executed in any number of
counterparts with the same effect as if all of the Members signed the same copy. All
counterparts will be construed together and will constitute one agreement.
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IN WITNESS WHEREOF, the parties have executed or caused to be executed
this Operating Agreement and do each hereby represent and warrant that their
respective signatory, whose signature appears below, has been and is, on the date of
this Agreement, duly authorized to execute this Agreement.
Dated: 01/07/2020
Signature of Eric Ryan Shibley
Signature of Thomas Dituri
EXHIBIT A
MEMBERS
The Members of the Company and their respective addresses, Capital Contributions, and
Ownership Interests are set forth below. The Members agree to keep this Exhibit A and
updated in accordance with the terms of this Agreement, including, but not limited
to, Sections 2.1, 2.3, 2.4, 7.1, 7.2, and 10.1.
Me mbers
Capital Percentage interest
Contribution
Eric Ryan Shibley 90% 90%
Address:
4700 36th Ave. SW
Seattle, Washington 98126
Thomas di’Turi 10% 10%
Address:
Seattle , WA
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I, KIM WYMAN, Secretary of State of the State of Washington and custodian of its seal, hereby issue this
CERTIFICATE OF EXISTENCE
OF
SFC LLC
I CERTIFY that the records on file in this office show that the above named entity was formed under the laws of the State of
Washington and that its public organic record was filed in Washington and became effective on 11/03/2017.
I FURTHER CERTIFY that the entity’s duration is Perpetual, and that as of the date of this certificate, the records of the
Secretary of State do not reflect that this entity has been dissolved.
I FURTHER CERTIFY that all fees, interest, and penalties owed and collected through the Secretary of State have been paid.
I FURTHER CERTIFY that the most recent annual report has been delivered to the Secretary of State for filing and that
proceedings for administrative dissolution are not pending.
Issued Date:
06/03/2020
UBI Number:
604 183 433
Given under my hand and the Seal of the State
of Washington at Olympia, the State Capital
Kim Wyman, Secretary of State
Date Issued: 06/03/2020
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Paycheck Protection Program
Borrower Application Form
1
SBA Form 2483 (04/20)
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Check One:
Sole proprietor Partnership C-Corp S-Corp LLC
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
DBA or Tradename if Applicable
Business Legal Name
Business Address
Business TIN (EIN, SSN)
Business Phone
( ) -
Primary Contact
Email Address
Average Monthly Payroll:
$
x 2.5 + EIDL, Net of
Advance (if Applicable)
Equals Loan Request:
$
Number of Employees:
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
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?
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 →
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?
OMB Control No.: 3245-0407
Expiration Date: 09/30/2020
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I
ES1 LLC
4700 36th Ave SW Seattle,WA 98126
2069384291
Eric SHibley
ers98126@gmail.com
38,300
95,750
6
I
I
I
I
employee benefits
Eric R Shibley
Manager
100
4700 36th Ave SW Seattle W
I
I
I
I
I
ers
I
ers
I
I
Paycheck Protection Program
Borrower Application Form
2
SBA Form 2483 (04/20)
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:
_____
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.
_____
Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_________________________________________________________
________________________
Signature of Authorized Representative of Applicant
Date
Print Name
Title
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ers
ers
ers
ers
ers
ers
ers
ers
SIGN
04/15/2020
Eric R Shibley
04/15/2020
Paycheck Protection Program
Borrower Application Form
3
SBA Form 2483 (04/20)
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
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 162 of 282
Paycheck Protection Program
Borrower Application Form
4
SBA Form 2483 (04/20)
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.
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 163 of 282
Paycheck Protection Program
Borrower Application Form
1
SBA Form 2483 (04/20)
☐
☐
(
☐☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Check One:
Sole proprietor Partnership C-Corp S-Corp LLC
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
DBA or Tradename if Applicable
Business Legal Name
Business Address
Business TIN (EIN, SSN)
Business Phone
( ) -
Primary Contact
Email Address
Average Monthly Payroll:
$
x 2.5 + EIDL, Net of
Advance (if Applicable)
Equals Loan Request:
$
Number of Employees:
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
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?
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 →
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?
OMB Control No.: 3245-0407
Expiration Date: 09/30/2020
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 164 of 282
I
ES1 LLC
4700 36th Ave SW Seattle,WA 98126
2069384291
Eric SHibley
ers98126@gmail.com
38,300
95,750
6
I
I
I
I
employee benefits
Eric R Shibley
Manager
100
4700 36th Ave SW Seattle W
I
I
I
I
I
ers
I
ers
I
I
Paycheck Protection Program
Borrower Application Form
2
SBA Form 2483 (04/20)
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:
_____
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.
_____
Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_________________________________________________________
________________________
Signature of Authorized Representative of Applicant
Date
Print Name
Title
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 165 of 282
ers
ers
ers
ers
ers
ers
ers
ers
04/15/2020
Eric R Shibley
04/15/2020
Paycheck Protection Program
Borrower Application Form
3
SBA Form 2483 (04/20)
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
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 166 of 282
Paycheck Protection Program
Borrower Application Form
4
SBA Form 2483 (04/20)
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.
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 167 of 282
Paycheck Protection Program
Borrower Application Form
1
SBA Form 2483 (04/20)
☐
☐
(
☐☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Check One:
Sole proprietor Partnership C-Corp S-Corp LLC
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
DBA or Tradename if Applicable
Business Legal Name
Business Address
Business TIN (EIN, SSN)
Business Phone
( ) -
Primary Contact
Email Address
Average Monthly Payroll:
$
x 2.5 + EIDL, Net of
Advance (if Applicable)
Equals Loan Request:
$
Number of Employees:
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
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?
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 →
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?
OMB Control No.: 3245-0407
Expiration Date: 09/30/2020
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 168 of 282
I
ES1 LLC
4700 36th Ave SW Seattle,WA 98126
2069384291
Eric SHibley
ers98126@gmail.com
38,300
95,750
6
I
I
I
I
employee benefits
Eric R Shibley
Manager
100
4700 36th Ave SW Seattle W
I
I
I
I
I
ers
I
ers
I
I
Paycheck Protection Program
Borrower Application Form
2
SBA Form 2483 (04/20)
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:
_____
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.
_____
Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_________________________________________________________
________________________
Signature of Authorized Representative of Applicant
Date
Print Name
Title
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 169 of 282
ers
ers
ers
ers
ers
ers
ers
ers
04/15/2020
Eric R Shibley
04/15/2020
Paycheck Protection Program
Borrower Application Form
3
SBA Form 2483 (04/20)
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
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 170 of 282
Paycheck Protection Program
Borrower Application Form
4
SBA Form 2483 (04/20)
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.
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 171 of 282
Paycheck Protection Program
Borrower Application Form
1
SBA Form 2483 (04/20)
☐
☐
(
☐☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Check One:
Sole proprietor Partnership C-Corp S-Corp LLC
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
DBA or Tradename if Applicable
Business Legal Name
Business Address
Business TIN (EIN, SSN)
Business Phone
( ) -
Primary Contact
Email Address
Average Monthly Payroll:
$
x 2.5 + EIDL, Net of
Advance (if Applicable)
Equals Loan Request:
$
Number of Employees:
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
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?
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 →
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?
OMB Control No.: 3245-0407
Expiration Date: 09/30/2020
Eric R Shibley MD PLLC
4700 36th Ave SW Seattle WA 98126
9052
Eric Shibley
shibleymedical@outlook.com
39,250
98,125
6
employee expenses
Manager
100
-5264
4700 36th Ave SW Seattle WA 98126
Eric R Shibley
ers
ers
206 938-4291
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 172 of 282
Paycheck Protection Program
Borrower Application Form
2
SBA Form 2483 (04/20)
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:
_____
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.
_____
Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_________________________________________________________
________________________
Signature of Authorized Representative of Applicant
Date
Print Name
Title
ers
ers
ers
ers
ers
ers
ers
ers
Manager
04/24/2020
Eric R Shibley
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 173 of 282
Paycheck Protection Program
Borrower Application Form
3
SBA Form 2483 (04/20)
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
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 174 of 282
Paycheck Protection Program
Borrower Application Form
4
SBA Form 2483 (04/20)
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.
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 175 of 282
Paycheck Protection Program
Borrower Application Form
1
SBA Form 2483 (04/20)
☐
☐
(
☐☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Check One:
Sole proprietor Partnership C-Corp S-Corp LLC
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
DBA or Tradename if Applicable
Business Legal Name
Business Address
Business TIN (EIN, SSN)
Business Phone
( ) -
Primary Contact
Email Address
Average Monthly Payroll:
$
x 2.5 + EIDL, Net of
Advance (if Applicable)
Equals Loan Request:
$
Number of Employees:
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
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?
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 →
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?
OMB Control No.: 3245-0407
Expiration Date: 09/30/2020
206 938-4291
Eric Shibley
shibley98271@gmail.com
94,000
6
4700 36th Ave SW Seattle WA 98126
37,600
Eric R Shibley
Manager
100
5264
4700 36th Ave SW Seattle WA 98126
ers
ers
3580
SFC LLC
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 176 of 282
Paycheck Protection Program
Borrower Application Form
2
SBA Form 2483 (04/20)
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:
_____
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.
_____
Current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_____
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.
_________________________________________________________
________________________
Signature of Authorized Representative of Applicant
Date
Print Name
Title
red
ers
ers
ers
ers
ers
ers
ers
04/25/2020
Manager
Eric R Shibley
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 177 of 282
Paycheck Protection Program
Borrower Application Form
3
SBA Form 2483 (04/20)
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
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 178 of 282
Paycheck Protection Program
Borrower Application Form
4
SBA Form 2483 (04/20)
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.
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12/3/2020
Gmail - Fwd: WOMPLY/HARVEST SBF- PPP NOTE & ACH AUTHORIZATION Loan #4593717205 for SS1 LLC
https://mail.google.com/mail/u/0?ik=8171ceaaf6&view=pt&search=all&permthid=thread-f%3A1670500502824352214&simpl=msg-f%3A1670500502824352214
1/5
Fwd: WOMPLY/HARVEST SBF- PPP NOTE & ACH AUTHORIZATION Loan
#4593717205 for SS1 LLC
1 message
From: Shibley Medical <shibleymedical@outlook.com>
Date: May 28, 2020 at 10:26:53 PM PDT
To: Jeremy Osaki <josaki@harvestcref.com>
Subject: Re: WOMPLY/HARVEST SBF- PPP NOTE & ACH AUTHORIZATION Loan #4593717205 for
SS1 LLC
Hi Jeremy,
Your boss called earlier and asked for couple of names to verify that they are working
on site , They know me by my name and 'A Team', they are :
1. Mataese Tela 9664
Phone: 206-629-2468
2.Eric Pula 2825
phone:253-740-2750
3.David sandoval/Tika 0074
Phone:206-326-8690
4.Ronald Reel 2237
Phone: 206-376-1683
5.Sam Morgan 3218
phone: 206-225-4313
6. Carlita Lopez 6676
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 274 of 282
12/3/2020
Gmail - Fwd: WOMPLY/HARVEST SBF- PPP NOTE & ACH AUTHORIZATION Loan #4593717205 for SS1 LLC
https://mail.google.com/mail/u/0?ik=8171ceaaf6&view=pt&search=all&permthid=thread-f%3A1670500502824352214&simpl=msg-f%3A1670500502824352214
2/5
Phone: 206-806-3150
7. Lisa Velotta 0046
phone : 206-929-5458
8. Jerome Muna 3416
phone : 253-785-1441
9. Sarieck Butler-Hem 9367
Phone: 206-376-6874
10.Ronisha Smith 0350
Phone: 206-566-9952
Please let me know when you are ready to send the funds back. I will send you a new
voided check.
Thank you.
From: Shibley Medical
Sent: Thursday, May 28, 2020 3:58 PM
To: Jeremy Osaki <josaki@harvestcref.com>
Subject: Re: WOMPLY/HARVEST SBF- PPP NOTE & ACH AUTHORIZATION Loan
#4593717205 for SS1 LLC
Just found out that number is not a federal case.
Sent from my iPhone
On May 27, 2020, at 3:38 PM, Shibley Medical <shibleymedical@outlook.com> wrote:
My cell phone is 2067717868. They started a federal case # 20SZ33 , that’s crazy, I am
dumbfounded.
Sent from my iPhone
On May 27, 2020, at 3:34 PM, Jeremy Osaki <josaki@harvestcref.com> wrote:
Hi there,
My apologies for the delay. Let me check with our Finance Team to see
what can be done and I’ll have someone from Finance reach out to
you, most likely some time tomorrow morning. What’s the best number
to reach you at?
Regards,
Jeremy Osaki
Senior Vice President
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 275 of 282
12/3/2020
Gmail - Fwd: WOMPLY/HARVEST SBF- PPP NOTE & ACH AUTHORIZATION Loan #4593717205 for SS1 LLC
https://mail.google.com/mail/u/0?ik=8171ceaaf6&view=pt&search=all&permthid=thread-f%3A1670500502824352214&simpl=msg-f%3A1670500502824352214
3/5
Asset Acquisition Specialist
josaki@harvestsbf.com
www.harvestsbf.com
<image001.png>
The content of this email is confidential and intended for the recipient specified in message only. It is
strictly forbidden to share any part of this message with any third party, without a written consent of the
sender. If you received this message by mistake, please reply to this message and follow with its
deletion, so that we can ensure such a mistake does not occur in the future.
From: Shibley Medical [mailto:shibleymedical@outlook.com]
Sent: Wednesday, May 27, 2020 11:25 AM
To: Jeremy Osaki <josaki@harvestcref.com>; pppnotes
<pppnotes@harvestcref.com>
Subject: Re: WOMPLY/HARVEST SBF- PPP NOTE & ACH
AUTHORIZATION Loan #4593717205 for SS1 LLC
Hi Jeremy,
This PPP loan ACH got returned back to your bank. Can you please send it to
another bank ? I will send you a voided check for the new account if that is
okay.
Thank you.
From: Shibley Medical <shibleymedical@outlook.com>
Sent: Tuesday, May 12, 2020 9:26 PM
To: Jeremy Osaki <josaki@harvestcref.com>;
pppnotes@harvestcref.com <pppnotes@harvestcref.com>
Subject: Re: WOMPLY/HARVEST SBF- PPP NOTE & ACH
AUTHORIZATION Loan #4593717205 for SS1 LLC
Hi Jeremy,
Do you have any update when the ACh will be initiated on this PPP loan,PPP
NOTE & ACH AUTHORIZATION Loan #4593717205 for
SS1 LLC
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 276 of 282
12/3/2020
Gmail - Fwd: WOMPLY/HARVEST SBF- PPP NOTE & ACH AUTHORIZATION Loan #4593717205 for SS1 LLC
https://mail.google.com/mail/u/0?ik=8171ceaaf6&view=pt&search=all&permthid=thread-f%3A1670500502824352214&simpl=msg-f%3A1670500502824352214
4/5
Thank you.
From: Jeremy Osaki <josaki@harvestcref.com>
Sent: Wednesday, May 6, 2020 1:59 AM
To: Shibley Medical <shibleymedical@outlook.com>
Subject: RE: WOMPLY/HARVEST SBF- PPP NOTE & ACH
AUTHORIZATION Loan #4593717205 for SS1 LLC
Please be sure to send your executed documents directly to
pppnotes@harvestcref.com or fax to 949.534.9007, if you haven’t already
done so.
Regards,
Jeremy Osaki
Senior Vice President
Asset Acquisition Specialist
josaki@harvestsbf.com
www.harvestsbf.com
<image001.png>
The content of this email is confidential and intended for the recipient specified in message only. It is
strictly forbidden to share any part of this message with any third party, without a written consent of the
sender. If you received this message by mistake, please reply to this message and follow with its
deletion, so that we can ensure such a mistake does not occur in the future.
From: Shibley Medical [mailto:shibleymedical@outlook.com]
Sent: Tuesday, May 05, 2020 12:20 PM
To: Jeremy Osaki <josaki@harvestcref.com>
Subject: Re: WOMPLY/HARVEST SBF- PPP NOTE & ACH
AUTHORIZATION Loan #4593717205 for SS1 LLC
Please find attached signed loan doc and voided check for ACH for the PPP
loan.
Thank you.
From: Jeremy Osaki <notifications@venturesgo.com>
Sent: Tuesday, May 5, 2020 7:35 AM
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 277 of 282
12/3/2020
Gmail - Fwd: WOMPLY/HARVEST SBF- PPP NOTE & ACH AUTHORIZATION Loan #4593717205 for SS1 LLC
https://mail.google.com/mail/u/0?ik=8171ceaaf6&view=pt&search=all&permthid=thread-f%3A1670500502824352214&simpl=msg-f%3A1670500502824352214
5/5
To: Eric Shibley <shibleymedical@outlook.com>
Subject: WOMPLY/HARVEST SBF- PPP NOTE & ACH
AUTHORIZATION
Dear Borrower,
Congratulations! Your PPP loan request has been approved by the SBA. Please
review and execute the attached PPP Note and ACH Authorization. Once
completed, please send the executed PPP Note and ACH Authorization and a
copy of a voided check from the account you would like your loan proceeds
deposited to pppnotes@harvestcref.com or fax to 949.534.9007. We are
working extremely hard on your behalf and anticipate disbursing funds
beginning on Friday, May 8th. We appreciate your patience. Thank you.
IMPORTANT: Please be sure to send all of the items below, in the same email
to pppnotes@harvestcref.com:
Executed PPP Note
Completed ACH Authorization
Copy of voided check/letter from bank (including Account Name,
Account#, Routing#)
Please include the SBA Loan Number and your Business Name
(found in your Note) in the subject line of the email to ensure timely
processing and disbursement of your funds.
PLEASE NOTE: If you already received loan documents from Round 1, you still
need to execute this new set of loan documents and return them in order for us
to comply with the Paycheck Protection Program Liquidity Facility.
The language in the PPP Note is non-negotiable, however if you identify any
errors in the loan amount and/or borrowing entity name, please contact
Jeremy Osaki at josaki@harvestsbf.com and copy (cc) support@womply.com to
ensure a timely response. For ALL other questions email
ppp@harvestcref.com. Thank you.
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 278 of 282
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 279 of 282
From: Mario Davis <mdavis@pinnaclesignature.com>
Sent: Thursday, June 25, 2020 9:48 PM
To: shibleymedical@outlook.com <shibleymedical@outlook.com>
Cc: Carol Dewey <cdewey@guardianpointepwm.com>; Phebe Fuqua
<pfuqua@pinnaclesignature.com>
Subject: Welcome
Hello Doctor,
Please find the attached application for you to complete so that we can begin reviewing your case.
Once we receive this back along with your documents discussed we can develop a strategy for moving forward.
Mario Davis
Senior Accountant for the firm
Pinnacle Signature Group Inc.
927 Beville Road Suite 109
South Daytona, Florida 32119
o.(386)675-6595
f. (386)675-6596
www.pinnaclesignature.com
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Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 280 of 282
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 281 of 282
Case 2:20-cr-00174-JCC Document 137-13 Filed 11/26/21 Page 282 of 282File and source
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- United_States_v._Shibley__wawd_2-20-cr-00174__doc137_att13__gov.uscourts.wawd.290911.137.13.pdf
- Size
- 16,598,869 bytes
- SHA-256
- 5d33a0e26fa72f6a247e8e649e079e1b645dc6e8d2519f35b5da3b7f1e8f4316
- Our copy
- United_States_v._Shibley__wawd_2-20-cr-00174__doc137_att13__gov.uscourts.wawd.290911.137.13.pdf
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