Confidential Financial Statement
Confidential Statement of Financial Capability:
Date:
Reviewer:
Request Agent:
(For confidential official use of the Town of Avon, Colorado and / or its agents)
1. a. Name
of Offerer:
b. Address:
The Land which the Offerer proposed to redevelop is described as follows:
The financial condition of the Offerer, as of (date), is as reflected in the
attached financial statement.
NOTE: Attach to this statement a certified financial statement showing the assets and liabilities, including contingent liabilities, fully itemized
in accordance with accepted accounting standards and based on a proper audit. If the date of the certified financial statement precedes the date of this submission by more than six
(6) months, also attach an interim balance sheet not more than sixty (60) days old.
a. Name and address of auditor or public accountant who performed the audit on which said financial
statement is based.
If funds for the development are to be obtained from sources other than the Offerer’s own funds, provide a statement of the Offerer’s plan for financing the acquisition
and development, indicating a proposed source and amount of equity investment, proposed source of debt financing, and evidence of ability to obtain financing.
Sources and amount of
cash available to Offerer to meet equity requirement of the proposed undertaking:
In Banks:
Name and Address of Bank Amount
By loans from affiliated or associated corporations or
firms:
Name and Address of Bank Amount
Confidential Statement of Financial Capability (cont’d):
By sale of readily saleable assets:
Description Market Value Mortgage or Liens
Name and address of bank and financial institution
references:
7. Has the Offerer or the parent corporation, or any subsidiary or affiliated corporation, if any, of the Offerer or said parent corporation, or any of the Offerer’s officers
or principal members, shareholders or investors, or other interested parties (as listed in the response to Item 3 of the “Statement of Qualifications”) been adjudged bankrupt, either
voluntary or involuntary, within the past 10 years?
Yes _______ No _______
Has the developer or anyone referred to in Number 7 above been indicated for or convicted of any felony
within the past 10 years?
Yes _______ No _______
If Yes, give for each case (a) date; (b) charge; (c) place; (d) court; and, (e) action taken. Attach any explanation deemed necessary.
Confidential Statement of Financial Capability (cont’d):
Certification
I (We)*, ________________________________________________________________________, certify that this Confidential
“Statement of Financial Capability” and the attached evidence of the financial responsibility, including financial statements, are true and correct to the best of my (our) knowledge
and belief and request that the information be treated confidentially.
Date:
Name Title
Firm Firm Address
Name Title
Firm Firm Address
* If the Offerer is a corporation,
this Statement should be signed by the President and Secretary of the corporation; if an individual, by such individual; if a partnership, by one of the partners; if an entity not having
a President and Secretary, by one of its chief officers having knowledge of the financial status and qualifications.