Sba Form 2182 Exhi Sbic Program Exhibit D

---

Overview

Cover
References

---

Sheet 1: Cover

								OMB Approval No. 3245-0062
								Expiration Date: MM/DD/YYYY
				409 3rd St., SW • Washington, DC 20416 • (202) 205-6510
				The SBIC Program
				Form 2182: Exhibit D
				List of References (Submit One Exhibit per Fund)
	Name of Applicant:		Name of Applicant, LP
			Firm
	Enter Principal Last Names:		Doe
			Partner
			Monroe
	Insert rows above this line --->
Please Note: SBA analysts conduct a thorough due diligence process on all SBIC Program applicants. This process includes reference calls to both "on-list" references you have included in this Exhibit as well as to "off list" references SBA analysts themselves identify. While SBA analysts will generally contact you before making reference calls, this may not always be the case. Please be aware that the reference calling process may begin immediately upon SBA's receipt of your application. If you have any special concerns about SBA contacting current employers, current partners, or any other on- or off-list references, please notify SBA in advance of submitting your application and include a cover letter with your application notifying us of your concerns.
SBA Form 2182 (07-13) Previous editions obsolete

---

Sheet 2: References

Name of Applicant, LP

References

Principal/Firm

First Name

Last Name

Title

Current Firm

Reference Type

Associated Fund or Co.

Associated Portfolio Company

Start Year of Relationship

End Year of Relationship

Work Phone

Mobile Phone

Home Phone

E-mail 1

E-mail 2

Notes

Firm

Bill

Smith

CEO

McKinley Engineering, Inc.

PC CEO

SBIC Capital Fund I

McKinley Engineering, Inc.

2002

2012

(987) 654-3210

(123) 456-7890

mark@exampleemail.com

Bill was brought on as CEO when the sponsor of this transaction initiated a management change at the time of financing. This was a deal led by former colleagues and thus is not associated with any principal in particular.

Partner

Susan

Anthony

Associate

Small Business Partners, Inc.

Departed Employee

SBIC Capital Fund I

2005

2008

(222) 222-2222

(111) 111-1111

santhony@sampleemail.com

Susan was an Associate with the firm for three years. She left the firm in 2008.

Doe

Thomas

Jefferson

CFO

Kennedy Plastics

PC CFO

SBIC Capital Fund II

VanBuren Construction

2003

2007

tj@email.com

Thomas was the CEO of VanBuren Construction, an SBIC Investors II portfolio company.

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x