Fillable Sba Form 1010-Anc - Alaska Native Corporation Information (Page 2 of 3) in pdf

3. Does the ANC own the applicant business concern through a

[ ]Yes

[ ]No

subsidiary(ies)? If yes, provide the name(s) and address(es) for the

concern(s).

Please provide the following documents:

Copy of the ANC’s Articles of Incorporation and Bylaws (including any amendments).



Copies of the governing documents of the subsidiary(ies) identified in Question 3 above.



For Corporations: Articles of Incorporation, Bylaws (including any amendments),



and stock certificates and register.

For Limited Liability Companies: Articles of Organization and Operating Agreement



(including all amendments).

Copies of minutes or other documentation from the ANC and/or the business concerns



identified in Question 3 above that relate to the applicant business concern (e.g., delegation of

authority, designation of representatives or directors, authorization for capitalization and/or

formation, etc.).

Copies of Federal tax returns, including all schedules, filed for the past three years for the



ANC and any business concern identified in Question 3 above.

Copies of the balance sheet and profit and loss statement for each of the three most recent



fiscal year-end periods, signed, certified, and dated by the highest managing individual for

the ANC and any business concern identified in Question 3 above.

NOTICE OF CRIMINAL PENALTIES AND ADMINISTRATIVE REMEDIES FOR

FALSE STATEMENTS: Under Title 18 U.S.C. § 1001 and Title 15 U.S.C. § 645, any

person who misrepresents a business concern’s status as an 8(a) Program participant, or

makes any other false statement in order to influence the certification process in any way,

or to obtain a contract awarded under the preference programs established pursuant to

section 8(a), 8(d), 9 or 15 of the Small Business Act, or any other provision of Federal Law

that reference Section 8(d) for a definition of program eligibility shall be: (1) Subject to

fines and imprisonment of up to 5 years, or both, as stated in Title 18 U.S.C. § 1001; (2)

subject to fines of up to $500,000 and imprisonment of up to 10 years, or both, as stated in

Title 15 U.S.C. § 645; (3) Subject to civil and administrative remedies, including

suspension and debarment; and (4) Ineligible for participation in programs conducted under

the authority of the Small Business Act.

CERTIFICATIONS: By signing this form, I certify that all information in this

application, including all supporting documents, is true and complete to the best of my

knowledge, and that I understand that SBA is relying on this information in making its

determination of my company’s eligibility for 8(a) BD Program.

Form must be signed by the ANC’s President or CEO.

___________________________

________________________

_________

Signature

Print Name

Date

Sba Form 1010-Anc - Alaska Native Corporation Information Page 2

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