Exhibit-A-Cover-Page.xlsx

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Attached to
SSBCI Technical Assistance to Capital Programs (Round 2)
Solicitation number
2139616
Issued by
New York

About this file

This is a cover sheet exhibit for the State Small Business Credit Initiative (SSBCI) Technical Assistance Grant Program administered by New York State's Empire State Development (ESD) Capital Access team. The document serves as the application cover page for organizations seeking to provide technical assistance services to eligible small business beneficiaries under Round 2 of the SSBCI TA funding initiative. Applicants must provide comprehensive organizational information including legal entity name, CDFI certification status, address, contact details, form of organization, and staffing information. The program targets two distinct tracks: Track One focuses on general technical assistance for loan capital to eligible business borrowers, while Track Two addresses contractor financing and surety bonding loan loss reserves. Technical assistance providers must demonstrate eligibility by meeting at least one of three criteria: maintaining a primary purpose or central mission of providing legal, accounting, and/or financial advisory services; regularly marketing themselves as providers of such services; or dedicating at least 25 percent of revenues or staff to these services.

The application requires detailed performance reporting across multiple years (2022-2025 projected) and beneficiary categories, including socially and economically disadvantaged individuals (SEDI)-owned businesses, very small businesses (VSBs), and other small enterprises. Applicants must disclose current or prior receipt of New York State assistance programs, including SSBCI funding, technical assistance grants, and other capital access initiatives. The document includes performance metrics tracking loan closures, delinquency ratios, and technical assistance delivery methods such as classroom training, one-on-one counseling, pre-loan and post-loan support, and specialized services in financial, accounting, and legal advisory areas. No specific contract term length, award date, or response deadline is indicated on this cover sheet, though the RFA structure indicates this represents a competitive selection process for qualified TA providers serving targeted beneficiary populations with demonstrated outcomes focus and no incumbent identified.

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Exhibit A

EXHIBIT A: COVER SHEET
Please provide all requested information in Fields BelowYes (see narrative)

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Comment:

Please add the three Eligibility for Respondents into three check off box at beginning of the Cover Sheet Reply:

Need to add bullet points here.State Small Business Credit Initiative (SSBCI) Technical Assistance Grant ProgramNo
Legal Name of Applicant (include d/b/a):CDFI Certification/Recertification Exp Date:

Street Address (not P.O. Box):

City: State: Zip: County:

Phone: Fax: Website: e-mail:

Executive Director/President:

Contact Name, Title and Telephone Number for this Proposal:

Federal Taxpayer I.D./Charity Reg. # (non-profits only): NYS State Unemployment Insurance Tax Number:

New York State SFS # (if applicable): New York State Prequalification # (non-profits only):

Vendor Responsibility # (if available):
Parent Organization Name (if applicable) :

Street Address (not P.O. Box):

City: State: Zip: County:

Form of Organization (i.e. For-Profit, Non-Profit). Please include the direct services your organization provides (i.e. legal, accounting, and/or financial advisory services):# of Organization Staff
# of Staff working on this project
# of Subcontractors working on this project
TotalDirect ServicesSubcontractor
Total Grant Requested:$0.00$0.00$0.00
Track One: General Technical AssistanceLoan Capital for eligible business borrowers

(see RFP for details on restrictions) Track Two: Contractor Financing and/or Surety Bonding Loan Loss Reserve for eligible loans (see RFP for details on restrictions)

A. Is this organization currently seeking any other New York State assistance (i.e. SSBCI EAC TA, CDFI, EAC, etc.)?
B. Has the organization applied for or received prior New York State technical assistance funding in the last five years? If yes, please list which programs and when.
C. Has the organization received SSBCI capital? If yes, please list which program.
D. Section IV of the U.S. Treasury Technical Assistance Grant Program guidelines describes whether an entity is legal, accounting, or financial advisory services provider. Specifically, entities must meet at least one of the following criteria:
a. A primary purpose of the entity or a central part of the entity's mission is to provide legal, accounting, and/or advisory services,
b. The entity regularly markets or publicizes itself as providing legal, accounting, and/or financial advisory services, or
c. At least 25% of the entity's revenues or staff are dedicated to providing legal, accounting, and/or financial advisory services.

Please add the three Eligibility for Respondents into three check off box at beginning of the Cover Sheet

Need to add bullet points here.

Exhibit D

2022202320242025 (Projected)
Only LendersNew York State Total Loan PerformanceTotalSEDISMEsVSBsOther Small BusinessesTotalSEDISMEsVSBsOther Small BusinessesTotalSEDISMEsVBSsOther Small BusinessesTotalSEDISMEsVSBsOther Small Businesses
a.Total # Loans Closed0000
b.Total $ Loans Closed$0$0$0$0
c.Delinquency Ratio (delinquent balance/total outstanding balance):1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1
d.Delinquency Ratio (delinquent balance/total outstanding balance):1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1:1
e.Class Room0000
h.# of One-on-One TA0000
i.Post-loan TA0000
j.Pre-loan TA0000
k.Financial advisory services0000
l.Accounting services0000
m.Legal services0000
TA ProvidersTechnical Assistance PerformanceTotalSEDISMEsVSBsOther Small BusinessesTotalSEDISMEsVSBsOther Small BusinessesTotalSEDISMEsVBSsOther Small BusinessesTotalSEDISMEsVSBsOther Small Businesses
a.Class Room0000
b.# of One-on-One TA0000
c.Post-loan TA0000
d,Pre-loan TA0000
e.Financial advisory services0000
f.Accounting services0000
g.Legal services0000
h.Total # Loans Referred
i.Total $ Loans Referred0000

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