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Thank you for your interest in a potential loan from the New York Shelter Acquisition and Predevelopment Fund. This survey is intended to gather the basic information that will make our first discussion more productive. This survey can be used with respect to a particular shelter or if you are seeking pre-qualification in advance of a particular project.

All the information provided will be held in confidence by SeaChange Capital Partners and its affiliated funds until we receive your permission to share it.

Organization Information

Organization Name

Street Address

Apt./Suite/Office

City

State

Zip

Website

EIN

Organization Contact Information

Primary Contact

Name

Title

Phone Number

Use format ###-###-####

Executive Director

Name

Phone Number

Use format ###-###-####

Please upload of copy of your tax exemption certificate.

Are you seeking a loan at this time or only to be pre-qualified as a potential borrower?

Please confirm that you have read the term sheet for the New York Shelter Acquisition and Predevelopment Fund.

Yes - I have reviewed the term sheet.

Shelter Information

What is the total amount of the loan you are seeking?

Please provide a description of the site including the address (with block and lots), the community board, the City Council District, and the Council Member.

Please describe the proposed shelter including proposed zoning SF, proposed gross SF, population type, and the # of beds/rooms/units.

Please briefly describe the proposed development process including any partners you expect to work with, the expected time frame, etc.

What is the current status of site control?

Please describe the status of your discussions with DHS and attach any relevant documents (Award Letter, etc)

Please describe the development team (architect, contractor, management company)?

What is the appraised value of the site?

Please attached the most recent appraisal (if available)

Please describe the current state of the development planning and attach any preliminary development pro-forma including sources and uses, development budget (hard and soft costs) unit distribution, expected rents, construction and permanent financing, and amortization schedule on permanent debt.

Please upload the preliminary proforma (if available)

Please upload any zoning analysis (if available)

Please upload any environmental analysis (Phase 1) (if available)

Please upload any schematic designs (if available)

Organizational Information

Please describe the mission and history of the organization and summarize it's current range of activities.

How would you describe your organization's financial health?

In your most recent fiscal year, did your organization show a surplus, deficit, or breakeven?

This fiscal year, do you anticipate a surplus, deficit, or breakeven?

Please list your top three (3) private, philanthropic funders with names and amounts for the last fiscal year:

What is your primary banking relationship? (Institution and contact information)

Please attach the three most recent audits, the three most recent Form 990s and the organizational budget for the current fiscal year.

Does the organization work with any company that the Executive Director, any member of staff, or any board member directly (or indirectly) has an economic interest in? If so, please describe.

If the organization is the subject of any meaningful litigation or lawsuits please describe them here?

As part of our vendor pre-qualification process, we would like to speak with three references who have worked closely with your organization during the past three years. Ideally, these will include a private funder, a development partner, and a community representative (elected or otherwise). Please list your suggest references with contact details here. We will not reach out to them without your explicit permission.

Please provide the name and contact information of the Chair of your Board of Directors.

Is there anything else you would like to tell us at this point?

Thank you for completing our survey! Your response is very important to us.

Please attached any other materials (up to three) that you would like us to review

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Contact Information